ABSTRACT
The management of abdominal leiomyosarcoma is challenging. Surgical excision is considered the only effective treatment; however, this is associated with considerable morbidity. Robotic surgery has emerged during the past decades and has enhanced the general surgery armamentarium, allowing surgeons to carry out demanding operations in a safe manner. The surgical resection of retroperitoneal leiomyosarcoma (RPLM) can be associated with significant morbidity, which is primarily due to the origin or the close proximity of the tumor with important vascular structures, including the inferior vena cava and tributaries, the duodenum and the ureter. The present case describes the first case of robotic resection of RPLM in a high-volume robotic center. In the present case, a large RPLM was safely removed with respect to oncological principles with the use of the Da Vinci platform.
ABSTRACT
PURPOSE: Review of the literature collecting trials comparing laparoscopic (LGD2) and open D2 gastrectomies (OGD2) for the treatment of advanced gastric cancer (AGC). METHODS: Randomized control trials (RCTs) and non-RCTs comparing LGD2 with OGD2 for AGC treatment, published between 1 January 2000 to 30 November 2017 were identified by searching the PubMed, EMBASE and Cochrane Library databases. Primary endpoints included operative outcomes (operative time, intraoperative blood loss, number of transfused patients and conversion rates), postoperative outcomes (postoperative analgesic consumption, time to first ambulation, time to first flatus, time to first oral intake, length of postoperative hospital stay, postoperative morbidity, incidence of reoperation and postoperative in-hospital mortality), and oncologic outcomes (number of harvested lymph nodes, tumor recurrence, disease-free rates and overall survival rates). The modified Newcastle-Ottawa scale was used to assess the quality of RCTs and non-RCTs in the study. RESULTS: Two RCT and 10 non-RCTs with a total of 2732 patients were included in the review. LGD2 when compared to OGD2 demonstrated significant lower intraoperative blood loss, shorter duration of analgesic administration, shorter times to first ambulation, flatus and oral intake, shorter postoperative hospital stay, lower incidence of nonsurgical complications. No significant differences were observed between LGD2 and OGD2 for the following criteria: postoperative in-hospital mortality, number of harvested lymph nodes, tumor recurrence, 5-year disease-free survival rates and five- or three-year overall survival rates. However, LGD2 had longer operative times. CONCLUSION: Although a technically demanding and time-consuming procedure, LGD2 offers the advantages of minimal invasion and can achieve the same degree of radical resections, harvested lymph nodes and short- or long-term prognosis for the treatment of locally AGC.
Subject(s)
Gastrectomy/methods , Laparoscopy/methods , Lymph Node Excision/methods , Stomach Neoplasms/surgery , Female , Humans , Male , Stomach Neoplasms/pathology , Stomach Neoplasms/therapyABSTRACT
Patients with postradiation therapy for malignancies and/or extensive colorectal surgery are prone to the development of enteroperineal fistulas. Application of biological meshes may prove beneficial in treating complicated enteroperineal fistulas as they provide a stable ground for closing pelvic defects even in contaminated fields.
ABSTRACT
INTRODUCTION: Transanal evisceration of small bowel is an extremely rare surgical emergency. Of the nearly 70 cases reported in the literature, rectal prolapse is the predisposing factor that has been most frequently related to this pathology. PRESENTATION OF CASE: We report a 78-year-old female with history of chronic rectal prolapse who presented in our emergency department with evisceration of small intestinal loops through the anus. In surgery after complete reduction of the eviscerated bowel into the peritoneal cavity, almost 20cm of the terminal ileum up to the ileocecal valve were necrotic and therefore a right hemicolectomy with primary anastomosis was performed. Additionally a 2cm craniocaudally tear was revealed in the antimesenteric border of the upper rectum and a Hartman procedure was also performed. The patient was discharged after 10 days. DISCUSSION: Early recognition and timely surgical intervention offers the best prognosis, avoiding a fatal conclusion or an extensive intestinal resection.
