En Bloc Kidney Transplant From a Pediatric Donor to a Pediatric Recipient Through a Total Extraperitoneal Approach: A Case Report.

En bloc kidney transplant remains a technically challenging procedure, especially in pediatric transplants. The intra-abdominal approach has been the preferred operation for very young children. However, the transverse incision could result in more abdominal muscle damage and intra-abdominal adhesions. If the extraperitoneal approach, which is the standard method for adult kidney transplant, could be performed in pediatric recipients, then adverse effects after a transverse incision could be avoided. A 30-month-old female recipient (13.1 kg) underwent an en bloc kidney transplant from a 36-month-old female donor (13.3 kg) who had cardiac arrest of unknown origin. The kidneys were retrieved with the en bloc technique using a bladder patch. A right Gibson incision was made along the lateral fascia of the rectus muscle of the recipient to prevent muscle fiber damage. The inferior vena cava and aorta of the donor were anastomosed to the inferior vena cava and right common iliac artery of the recipient, respectively. The bladder patch with 2 ureteral openings was directly anastomosed to the bladder of the recipient. Urination was excellent immediately after the operation. The recipient recovered quickly. The total extraperitoneal approach is feasible and has some advantages over the transverse incision, even in pediatric recipients.

Outcomes of liver resection in patients with colorectal liver metastases by laparoscopic or open surgery.

BACKGROUNDS/AIMS: Colorectal cancer is found with liver metastases about 20-25% due to characteristics of cancer itself. Approximately 20% of liver metastases are found to be resectable. The objective of this study was to evaluate short-term outcomes of patients who received liver resection with colorectal cancer operation in our center by laparoscopic surgery or open surgery. METHODS: Short-term outcomes of laparoscopic surgery of liver resection (LSLR) group who underwent liver resection for colorectal liver metastases (CRLM) at a single institute from 2013 to 2016 were compared to those of open surgery of liver resection (OSLR) group. RESULTS: A total of 123 patients underwent liver resection for CRLM, including 101 (82.1%) patients in the OSLR group and 22 (17.9%) patients in the LSLR group. There were significant differences in tumor characteristics between the two groups, including synchronous and metachronous (p=0.004), tumor number (p<0.001), and tumor margin (p=0.002). For postoperative outcomes, only the length of hospital stay (LOS) was significantly different between the two groups (8.5 days in LSLR vs. 11 days in OSLR, p<0.001). There was no significant difference in overall rate of postoperative complications between the two groups (9.1% in LSLR vs. 23.8% in OSLR, p=0.158). CONCLUSIONS: There are no significant differences in postoperative outcomes between LSLR and OSLR except LOS, liver metastasis number, and resection margin. LSLR may be favorable for highly selected patients with CRLM.

Prognostic significance of 18F-FDG PET/CT in patients with colorectal cancer liver metastases after hepatectomy.

INTRODUCTION: Colorectal cancer liver metastasis (CRLM) can be cured with surgery. To improve survival, optimal selection of CRLM patients should be done cautiously, which may be facilitated by preoperative [F-18] fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). METHODS: A total of 245 patients with CRLM between February 2007 and January 2015 were retrospectively studied. All clinical variables, pathological data, and various PET/CT parameters were correlated with disease-free survival (DFS) and overall survival (OS). Metastatic tumor maximum standardized uptake value (SUVmax) and normal liver mean SUV (SUVmean) ratio was selected for group classification. RESULTS: The median DFS in months were 24.5 months and median OS were 41.7 months. Multivariate analysis found an increased risk of worse prognosis in DFS for primary colon cancer T3∼T4, N2 stage, neoadjuvant chemotherapy, synchronous metastasis, multiple metastatic tumor number and metastatic tumor SUVmax/normal liver SUVmean ratio >4.3. The DFS rate of each group classified by SUV ratio was 58.1%, 39.0%, and 33.6% vs. 39.3%, 20.8%, and 15.8% at 1, 3, and 5 years (p = 0.017). Patients with multiple tumors and SUV ratio of >4.3 showed worst survival (OS rate: 74.2%, 41.5%, and 24.2%, p = 0.001 at 1, 3, and 5 years, respectively). CONCLUSIONS: PET/CT variables can be a valuable prognostic factor in patients with CRLM for the prediction of recurrence. Preoperative PET/CT may improve risk stratification and optimize outcomes of patients with CRLM.