Propensity score-matched comparison of short-term and long-term outcomes between endoscopic submucosal dissection and surgery for treatment of early gastric cancer in a Western setting.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a standard treatment option for early gastric cancer (EGC) in Asia; however, data about ESD efficacy in Western populations are limited. Furthermore, outcomes of EGC treatment after ESD or surgery have not been compared in Western cohorts. This study aimed to compare short-term and long-term results of ESD and surgery for EGC. METHODS: This retrospective case-control study included patients with EGC treated in two largest cancer centers in Eastern Lithuania between 2005 and 2016. Propensity score nearest-neighbor 1:1 matching, based on clinicopathologic characteristics, was performed between patients who underwent ESD and surgery. The primary endpoint of the study was 5-year disease-free survival (DFS). RESULTS: Of 260 eligible patients, 42 (16.1%) underwent ESD. After matching, two well-balanced groups consisting of 42 patients in each were analyzed. The operation time (83 vs. 151 min., p = 0.001) and postoperative hospitalization stay (5.4 vs. 13.4 days, p = 0.001) was significantly shorter in the ESD group. 5-year DFS rate was significantly higher in the surgery group (97.6% vs. 77.5%, p = 0.002). However, this difference was reduced after exclusion of non-curative ESD cases (97.6% vs. 89.7%, p = 0.099). There was no significant difference in 5-year OS rate between the study groups (73.8% vs. 69.0%, p = 0.599). CONCLUSIONS: ESD might be an excellent alternative to surgery for EGC if curative resection is achieved. Non-curative ESD is associated with poor DFS and high rate of recurrence. Additional surgery should be recommended after non-curative ESD whenever treatment-associated risk is acceptable.

Giant gluteal lipoma presenting as a sciatic hernia.

BACKGROUND: Sciatic hernia is considered to be the rarest hernia of pelvic floor with less than one hundred reports published worldwide. Lipoma in the hernia sac is even more unique pathology with only few cases reported in the literature. We report a case of gluteal lipoma protruding into pelvis, displacing rectum with bladder and presenting as a sciatic hernia. CASE PRESENTATION: A 53-year-old male presented with an expanding, slightly reducible, right gluteal painful mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, other symptoms­6 months. No spinal pathology was found on X-ray. On examination patient seemed well nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Computer tomography (CT scan) demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumor was surgically removed through lower middle laparotomy approach. Subsequent pathological examination revealed lipoma. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery. CONCLUSION: The presence of a gluteal mass should always suggest the possibility of a sciatic hernia.

Giant gluteal lipoma presenting as a sciatic hernia.

BACKGROUND: Sciatic hernia is considered to be the rarest hernia of pelvic floor with less than one hundred reports published worldwide. Lipoma in the hernia sac is even more unique pathology with only few cases reported in the literature. We report a case of gluteal lipoma protruding into pelvis, displacing rectum with bladder and presenting as a sciatic hernia. CASE PRESENTATION: A 53-year-old male presented with an expanding, slightly reducible, right gluteal painful mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, other symptoms-6 months. No spinal pathology was found on X-ray. On examination patient seemed well nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Computer tomography (CT scan) demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumor was surgically removed through lower middle laparotomy approach. Subsequent pathological examination revealed lipoma. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery. CONCLUSION: The presence of a gluteal mass should always suggest the possibility of a sciatic hernia.

Combined treatment of uveal melanoma liver metastases.

Uveal melanoma (UM) is the most prevalent intraocular malignant tumor in the Western world. The prognosis of survival in the presence of metastatic disease is 2-7 months, depending on the treatment applied. - This article presents a case of metastatic UM with successful complex treatment of liver metastases. - A 49-year old female, underwent removal of the right eyeball in 1996 due to a histologically confirmed uveal melanoma. After 11 years, CT revealed a mass in the left kidney and multiple metastases in the liver. After left nephrectomy, 6 chemotherapy courses with dacarbazine were performed. The increasing liver metastases were observed. Additional 4 intraarterial (i/a) chemotherapy courses were administered using cisplatin, doxorubicin, fluorouracil, and interferon alfa. After few courses increase in CTC Grade 4 liver transaminases was seen. A partial response was observed, and in December 2008 the patient underwent surgery removing all liver metastases by 7 wedge or atypical resections. All margins were tumor-free. 21 months after liver resections and 14 years since dia?gnosis, the patient is alive without evidence of disease. - Successful treatment of metastatic uveal melanoma was due to a timely application of a combination of several treatment methods and good prognostic factors of the patient.

Evaluation of two methods of endoscopic adrenalectomy.

OBJECTIVE: The aim of this study was to analyse the results of minimally invasive adrenalectomy and to compare the advantages and weaknesses of two methods of operation. PATIENTS AND METHODS: The outcomes of 70 patients operated on between 2000 and 2006 because of lesions of the adrenal glands were analysed. The patients were allocated to two groups: 40 patients underwent laparoscopic adrenalectomy (group A), and 30 patients underwent retroperitoneal endoscopic adrenalectomy (group B) (1 patient had bilateral lesions of the adrenals). Blood loss during the operation, incidence of complications and conversions, duration of operation, size of tumour and patient's body mass index (BMI) were analysed. RESULTS: Median tumour size was 3.49 +/- 1.27 cm (range: 2-7 cm) in group A, and 3.9 +/- 1.38 cm -(range: 1.4-6 cm) in group B. More than half of all patients (n = 38; 54.3 %) were operated on because of a non-functional adrenal adenoma. Conversion was performed on 5 patients (12.5 %) in group A and on 1 patient (3.3 %) in group B. Operation time in group A was 122 +/- 30.42 min, and in group B 135 +/- 57.05 min. The training period for laparoscopic adrenalectomy was shorter. There were no significant differences in blood loss during operation or incidence of complications. The size of the tumour and the patient's BMI did not have a statistically significant impact on the duration of operation. CONCLUSIONS: Laparoscopic and retroperitoneal endoscopic adrenalectomies are of the same value in most aspects. However, the training period for laparoscopic adrenalectomy was shorter.