Gastrointestinal Surgery

Intradiaphragmatic Bronchogenic Cysts

The Vein of Henle Revisited

Effective and Safe Living Donor Hepatectomy Under Intermittent Inflow Occlusion and Outflow Pressure Control

Gastric Synovial Sarcoma

Giant Primary Retroperitoneal Dedifferentiated Liposarcoma

Primary Sarcomatoid Malignant Mesothelioma of the Pancreas

Ileal Endometriosis: a Rare Cause of Enterocutaneous Fistula

Robotic Single-Site Plus One Port: Pancreas Enucleation Abstract Purpose Laparoscopic approaches to enucleation of the pancreas have been frequently described. Here we present a case of robotic single-site plus one port pancreas enucleation. To our knowledge, this enucleation surgical technique is the first to be reported in the medical literature. Methods A 46-year-old male patient without previous medical or surgical history was incidentally diagnosed with a pancreatic mass during evaluation of intermittent right flank pain. Robotic single-site plus one port pancreas enucleation was performed using the Da Vinci single-site surgical platform with one additional port on November 16, 2016. Usual robotic instruments such as hook, bipolar, and vessel sealer with endo-wrist function could be used to facilitate effective surgical procedure with the additional port. The resected specimen was delivered through the umbilicus and a drain was not inserted. Results Total operation time was 124 min with total console time of 73 min. Estimated blood loss was 50 cm3. Final pathology result was neuroendocrine tumor, grade 1. The patient was discharged without any complications on postoperative day #4. Conclusions Robotic single-site plus one port pancreas enucleation seems feasible with acceptable perioperative outcomes.

Outcomes After Resection of Hepatocellular Carcinoma: Intersection of Travel Distance and Hospital Volume Abstract Background Data on the impact of hospital volume and travel distance on patient outcomes after major abdominal surgery remain poorly defined. We sought to characterize the relationship of travel distance, hospital volume, and long-term outcomes of patients undergoing surgical resection of hepatocellular carcinoma (HCC). Methods The 2004–2015 National Cancer Database was used to identify patients who underwent resection of HCC. Patients were stratified according to travel distance and hospital volume quartiles, and multivariable regression models were utilized to examine the impact of travel distance, hospital volume, and travel distance/hospital volume on overall survival (OS). Results Among the 12,266 patients identified, procedures included wedge/segmental resections (N = 7354, 59.9%), hemi-hepatectomy (N = 4003, 32.6%), and extended hepatectomy (N = 909, 7.5%). Stratifying data into quartiles, travel distance to surgical care was ≤ 5.7 miles (mi), > 5.7–14.2 mi, > 14.2–44.4 mi, and ≥ 44.4 mi, while hospital volume quartiles determined on the hospital level were ≤ 1 case per year, 1.1–4, 4.1–12.5, and ≥ 12.5. On multivariable analysis, increased hospital volume was associated with decreased hazard of mortality (HR 0.69, 95% CI 0.45–0.82, p < 0.001). Travel distance was not significantly associated with hazard of mortality. Furthermore, only hospital volume was associated with mortality (HR 0.67, 95% CI 0.56–0.80, p < 0.001) after controlling for both travel distance and hospital volume. Conclusions Only hospital volume was associated with increased hazard of mortality. The benefits of undergoing resection for HCC at a high-volume hospital appear to outweigh the inconvenience of longer travel distances.

A Prognostic Scoring System for the Prediction of Metastatic Recurrence Following Curative Resection of Pancreatic Neuroendocrine Tumors Abstract Background Patients with early-stage pancreatic neuroendocrine tumors (PNETs) may develop metastatic recurrences despite undergoing potentially curative pancreas resections. We sought to identify factors predictive of metastatic recurrences and develop a prognostication strategy to predict recurrence-free survival (RFS) in resected PNETs. Methods Patients with localized PNETs undergoing surgical resection between 1989 and 2015 were identified. Univariate and multivariate analysis were used to identify potential predictors of post-resection metastasis. A score-based prognostication system was devised using the identified factors. The bootstrap model validation methodology was utilized to estimate the external validity of the proposed prognostication strategy. Results Of the 140 patients with completely resected early-stage PNETs, overall 5- and 10-year RFS were 84.6% and 67.1%, respectively. The median follow-up was 56 months. Multivariate analysis identified tumor size > 5 cm, Ki-67 index 8–20%, lymph node involvement, and high histologic grade (G3, or Ki-67 > 20%) as independent predictors of post-resection metastatic recurrence. A scoring system based on these factors stratified patients into three prognostic categories with distinct 5-year RFS: 96.9%, 54.8%, and 33.3% (P < 0.0001). The bootstrap model validation methodology projected our proposed prognostication strategy to retain a high predictive accuracy even when applied in an external dataset (validated c-index of 0.81). Conclusions The combination of tumor size, LN status, grade, and Ki-67 was identified as the most highly predictive indicators of metastatic recurrences in resected PNETs. The proposed prognostication strategy may help stratify patients for adjuvant therapies, enhanced surveillance protocols and future clinical trials.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com