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Chyle leakage/ascites after surgical resection of neuroblastic tumors may delay the start of chemotherapy and worsen prognosis. Previous studies have reported a highly variable incidence and risk factors remain largely unknown. This study aims to analyze the true incidence of chyle leaks and ascites and seeks to identify risk factors and optimal treatment strategies. Medline/Embase databases were searched according to PRISMA guidelines. Literature reviews, case reports, and non-English papers were excluded. Data were extracted independently following paper selection by 2 authors. The final analysis yielded 15 studies with N = 1468 patients. Chylous ascites was recorded postoperatively in 171 patients (12%). Most patients experiencing chyle leaks were successfully treated conservatively with drainage, bowel rest, parenteral nutrition and octreotide with variable combinations of these treatment options. 7/171 (4%) patients required operative exploration to control troublesome persistent chyle leaks. In risk factor analysis, higher tumor stage was significantly associated with the risk of chyle leak (P < 0.0001) whereas no correlation was observed with adrenal vs non-adrenal tumor location, INRG risk groups and tumor laterality. Chyle leakage after surgery for neuroblastic tumors is a common morbid complication occurring in some 12% of patients. Higher INSS tumor stage portends greater risk(s). Conservative therapy strategies appear successful in the majority of cases. To avert this complication meticulous mesenteric lymphatic ligation is recommended especially for those patients with higher tumor stage(s) requiring extensive radical surgery including retroperitoneal lymph node resection. III. Systematic review. • Chyle leak after surgical resection of neuroblastic tumors may delay the start of chemotherapy and its risk factors remain largely unknown. • To avert this complication meticulous mesenteric lymphatic ligation is recommended especially for those patients with higher tumor stage(s) requiring extensive radical surgery. [ABSTRACT FROM AUTHOR]

• Systematic review and meta -analysis of 20 studies of 12,022 patients with early rectal cancer. • LR may be appropriate for selected patients without poor prognostic factors. • Staging methods and surveillance protocols are underreported in the literature. • Standardisation of staging and surveillance is essential in management of early rectal cancer. Local resection (LR) methods for rectal cancer are generally considered in the palliative setting or for patients deemed a high anaesthetic risk. This systematic review and meta -analysis aimed to compare oncological outcomes of LR and radical resection (RR) for early rectal cancer in the context of staging and surveillance assessment. A literature search of MEDLINE, Embase and Emcare databases was performed for studies that reported data on clinical outcomes for both LR and RR for early rectal cancer from January 1995 to April 2023. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. The quality of assessment was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias 2.0 tool for randomised controlled trials. Twenty studies with 12,022 patients were included: 6,476 patients had LR and 5,546 patients underwent RR. RR led to an improvement in 5-year overall survival (OR 1.84; 95 % CI 1.54–2.20; p < 0.0001; I 2 20 %) and local recurrence (OR 3.06; 95 % CI 2.02–4.64; p < 0.0001; I 2 39 %) when compared to LR. However, when staging and surveillance methods were clearly adopted in LR cases, there was an improvement in R0 rates (96.7 % vs 85.6 %), 5-year disease-free survival (93.0 % vs 77.9 %) and overall survival (81.6 % vs 79.0 %) compared to when staging and surveillance was not reported/performed. LR may be appropriate for selected patients without poor prognostic factors in early rectal cancer. This study also highlights that there is currently no single standardised staging or surveillance approach being adopted in the management of early rectal cancer. A more specified and standardised preoperative staging for patient selection as well as clinical and image-based surveillance protocols is needed. [ABSTRACT FROM AUTHOR]

The rate of recurrence and metastasis of non-small cell lung cancer after radical resection is still very high. The risk factors for recurrence and metastasis have been extensively studied, but the dynamic pattern of postoperative recurrence hazard over time is relatively lacking. The dynamic recurrence hazard rate curve is applied to describe the rate of recurrence at any point time among the "at-risk" patients. In this article, by reviewing the previous literature, the characteristics of the dynamic recurrence and metastasis pattern after radical resection of non-small cell lung cancer and the clinical factors affecting the recurrence and metastasis pattern are summarized, in order to screen out specific populations with high recurrence risk and give them personalized follow-up strategy and diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The agreement between the radiologic and histopathologic tumor locations in T2 gallbladder cancer is critical. There is no consensus regarding the extent of curative resection by tumor locations. Between January 2010 and December 2019, a consecutive series of 118 patients with pathological T2 gallbladder cancer who underwent surgery were retrospectively analyzed in terms of the accordance between radiologic and histopathologic tumor locations, the extents of hepatic resection and the numbers of harvested lymph nodes. Radical resection was defined as liver resection with harvesting of at least four lymph nodes. The accuracy of preoperative tumor localization was only 68%. After radical resection, the 5-year overall survival (OS) was 59.4%; after nonradical resection, the figure was 46.1% (p = 0.092). In subanalyses, the 5-year OS was marginally better for patients who underwent liver resection or from whom at least four lymph nodes were harvested than those who did not undergo liver resection or from whom three or fewer lymph nodes were harvested (58.2% vs. 39.4%, p = 0.072; 59.9% vs. 50.0%, p = 0.072, respectively). In patients with peritoneal side tumor, the 5-year OSs of those who did and did not undergo liver resection were 67% and 41.2%, respectively (p = 0.028). In multivariate analysis, perineural invasion and radical resection were independently prognostic of OS. The accuracy of preoperative tumor localization was 68%. Hepatic resection, lymph node dissection harvesting of at least four lymph nodes are required for curative resection for gallbladder cancer, regardless of tumor location. [ABSTRACT FROM AUTHOR]

Biliary cystadenoma (BC) is a benign hepatic cystic tumor with degenerative potential. Hepatic MRI can help guide the diagnosis. Surgical resection is recommended due to the malignant potential of biliary cystadenomas. Only anatomopathological examination of the surgical specimen can establish the definitive diagnosis of BC. The objective of this case report is to enhance our understanding of this disease and contribute to precise diagnosis for optimal management. A 55-year-old woman with a history of hypertension and atrial fibrillation presented to the surgery department with paroxysmal right hypochondrial pain. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) revealed a large septated cystic lesion occupying segments II, III, and IV of the liver. The patient underwent left hepatectomy without incident. The postoperative course was marked by a deep collection opposite the sectional area, which was successfully treated with antibiotics and radiological drainage. The pathological diagnosis confirmed BC without signs of malignancy, and no recurrence was detected post-surgery. The rarity of BC, the absence of specific clinical signs and its potential for malignant transformation, underline the need for sophisticated imaging techniques. However, preoperative radiological diagnosis does not exceed 50 %. The operative decision requires a multidisciplinary discussion between radiologists and surgeons. This case highlights the unavailability of radical surgical treatment in cases of strong preoperative suspicion of BC. The cooperation of the pathologist in the histological diagnosis is crucial. The diagnosis of BC should be considered in cases of multilocular cystic lesions in the liver, particularly in instances of recurrent cysts. Imaging aids in both positive and differential diagnoses. Complete resection is the recommended treatment for any suspected BC. • Rare benign tumor with malignant potential • Case presentation and diagnostic techniques • Multidisciplinary approach and postoperative management • Importance of imaging in diagnosis and treatment planning [ABSTRACT FROM AUTHOR]

This study was designed to discuss the clinical effects of dexmedetomidine combined with oxycodone patientcontrolled intravenous analgesia for patients with laparoscopic radical resection of rectal cancer. A total of 90 patients with rectal cancer undergoing laparoscopic radical resection surgery were selected. The patients were divided into A, B and C group using a random number table method, 30 cases in each group. Patients in group A received oxycodone (O) alone postoperatively; patients in group B received dexmedetomidine combined with oxycodone (DO) postoperatively; and patients in group C received dexmedetomidine (D) alone postoperatively. The Visual Analog Scale (VAS) score and Ramsay sedative score at 2h, 6h, 24h and 48h after surgery were evaluated, and the effective compressions number of controlled intravenous analgesia (CIA) was recorded. The occurrence of side effects including fever, nausea, vomiting, drowsiness, dizziness, itchy skin, respiratory depression and other adverse reactions were noted. CRP, TNF-a, and IL-6 were detected by ELISA prior to surgery and on the morning of the 1st and the 3rd day after surgery, respectively. VAS scores in group B were lower than group A and C, the effective compressions number of CIA in group B was less than group A and C, the incidence of adverse reactions in group B was lower than group A and group C. The levels of CRP, TNF-a and IL-6 at 72h after surgery in group B were lower than group A and C. Dexmedetomidine combined with oxycodone has better sedative and analgesic effects with less adverse reactions, it can reduce the release of inflammatory cytokines of CRP, TNF-a and IL-6 in the body and has certain clinical application value. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety of radical resection for retroperitoneal sarcoma (RPS). Background: The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resection has not been shown in a large study population. Methods: The Transatlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaborative of sarcoma centers. A combined experience of 1007 consecutive resections for primary RPS from January 2002 to December 2011 was studied retrospectively with respect to adverse events. A weighted organ score was devised to account for differences in surgical complexity. Univariate and multivariate logistic regression analyses were performed to investigate associations between adverse events and number and patterns of organs resected. Associations between adverse events and overall survival, local recurrence, and distant metastases were investigated. Results: Severe postoperative adverse events (Clavien-Dindo ≥3) occurred in 165 patients (16.4%) and 18 patients (1.8%) died within 30 days. Significant predictors of severe adverse events were age ( P = 0.003), transfusion requirements ( P < 0.001), and resected organ score ( P = 0.042). Resections involving pancreaticoduodenectomy, major vascular resection, and splenectomy/pancreatectomy were found to entail higher operative risk (odds ratio >1.5). There was no impact of postoperative adverse events on overall survival, local recurrence, or distant metastases. Conclusions: A radical surgical approach to RPS is safe when carried out at a specialist sarcoma center. High-risk resections should be carefully considered on an individual basis and weighed against anticipated disease biology. There appears to be no association between surgical morbidity and long-term oncologic outcomes. [ABSTRACT FROM AUTHOR]

Objective: Radical resection is regarded as the primary treatment for early rectal cancer, and tumor volume is an independent predictor of many other types of cancer. The purpose of the present study is to assess the effect of tumor volume on the survival of patients with early rectal cancer treated with radical surgery.Methods: A total of 270 patients with histologically confirmed stage T1/2 N0 rectal cancer who underwent radical resection between September 2006 and September 2014 were enrolled in this study. The tumor volume was measured based on the preoperative pelvic MRI. The clinical significance of tumor volume with respect to patients' outcomes was evaluated, and the multivariate Cox proportional regression model was used to analyse the risk factors for survival of these patients.Results: The median follow-up period was 57.6 months. The tumor volume was significantly correlated with preoperative Hb, CEA level and number of retrieved lymph nodes (all p < 0.05). The large tumor group had a lower disease-free survival (DFS) rate than the small tumor group (5-year DFS rate: 80.4% vs 89.6%, p = 0.042), whereas there was no difference in the overall survival rate. The 5-year local recurrence rates for patients in the large and small tumor groups were 10.5% and 3.0%, respectively (p = 0.030). Additionally, the tumor volume was an independent clinical predictor for both DFS and local recurrence-free survival (LRFS).Conclusion: In conclusion, the tumor volume is significantly associated with DFS and LRFS of patients with stage T1/2 N0 rectal cancer who underwent radical resection alone. Tumor volume may be considered an important indicator for neoadjuvant or adjuvant therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: Numerous distant metastases were not detected preoperatively. Positron emission tomography (PET) has been used for oncology diagnosis recently. However, it remains controversial whether PET modality is a more efficient way in detecting unresectable features for radical resection of pancreatic cancer (PC). This meta-analysis aims to validate the efficiency of PET modalities (including PET and PET/CT) in preoperative assessment of PC, and compare them with computed tomography (CT).Methods: PubMed, EMBASE, Science Citation Index and The Cochrane Library were searched to identify relevant studies. Both PET modality and CT had been performed for all the included patients. A meta-analysis was performed to compare the ability of PET modalities in detecting occult distant metastases and regional lymph nodes invasion with that of CT.Results: 17 clinical studies that recruited 1343 patients were included. This meta-analysis indicated that PET modalities were more efficient in detecting true positive distant metastases compared with CT (OR = 1.52, 95%CI: 1.23-1.88). In subgroup analysis, when compared with CT alone, PET/CT also showed greater utility in detecting distant metastases (OR = 1.66, 95%CI: 1.31-2.08). There was no definite difference in detecting regional lymph nodes invasion between PET modalities and CT (OR = 0.97, 95%CI: 0.63-1.47).Conclusion: Compared with CT, PET/CT provides extensive possibility to avoid futile radical resection by detecting occult metastases of PC preoperatively. Surgeons, especially in developing countries, should take PET modalities as a routine preoperative assessment before making operative plan for PC patients. [ABSTRACT FROM AUTHOR]

Background Research on the clinicopathology and prognosis of gastric neuroendocrine carcinoma (GNEC) is rare, and a uniform standard for treatment has not been established. Therefore, we retrospectively analyzed the clinical data of 132 cases of GNEC to investigate the factors influencing prognosis. Methods A total of 132 patients diagnosed with GNEC at Fujian Medical University Union Hospital from January 2006 to December 2013 were enrolled. This study was performed to analyze the factors related to patient prognosis. Results In total, 58 men and 74 women whose ages ranged from 38 to 83 years old (62 ± 10) were enrolled. The 1- and 3-year survival rates for these patients were 83.9% and 47.6%, respectively. Of these patients, 100 underwent radical resection, 22 underwent palliative resection, and 10 received chemotherapy alone. The median survival times following radical resection, palliative resection and chemotherapy alone were 48, 20 and 12 months, respectively (P < 0.01). Univariate and multivariate survival analyses of patients who underwent radical resection showed that tumor size, N stage, Ki-67 labeling index, mitotic index and the application of postoperative adjuvant chemotherapy were independent factors affecting patient prognosis. The correlation analysis of the Ki-67 labeling index and mitotic index with prognosis showed that patient survival decreased significantly when the Ki-67 labeling index increased (P < 0.05). Conclusions Patients who underwent radical resection had the best prognosis among GNEC. For these patients, tumor size, N stage, Ki-67 labeling index, mitotic index and the application of postoperative adjuvant chemotherapy were the clinicopathological factors significantly associated with patient prognosis. [ABSTRACT FROM AUTHOR]

Background Malignant peripheral nerve sheath tumor is an uncommon tumor of the peripheral nerves. The commonest presenting symptom is soft tissue mass and pain with local neurological findings. Imaging modalities are unhelpful in making a reliable diagnosis. Treatment is radical resection with adequate clear resection margins. Radiotherapy improves the local control, but the prognosis remains poor especially in those with divergent differentiation. Summary A 23-year-old man with no history of neurofibromatosis presented with a swelling on the back which has been gradually increasing in size and causing him discomfort. The tumor was surgically excised and the histopathological examination revealed malignant peripheral nerve sheath tumor with extensive osseous and cartilaginous differentiation. He developed pulmonary metastases one year after the surgical resection. Pulmonary metastatectomy was therefore performed and the histopathology of the metastatectomy specimen revealed metastatic malignant peripheral nerve sheath tumor, but without any osseous or cartilaginous differentiation. He remained well with no recurrence or metastases at 9-month follow-up. Conclusion Malignant peripheral nerve sheath tumor is a malignant tumor that behaves aggressively despite adequate radical resection. This case also illustrates extensive osseous and cartilaginous divergent differentiation of the primary tumor which was surprisingly absent in the metastatic lesions. This finding warrants further research. [ABSTRACT FROM AUTHOR]

Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rarely, GISTs can be located in mesentery, retroperitoneal space, omentum or pancreas. In these cases, the neoplasm is defined as “extra-gastrointestinal stromal tumors” (EGISTs). Presentation of case We reported a case of a 63-year-old male patient diagnosed by computer tomography with large intraabdominal tumor with vague origin, postoperatively determined as an EGIST. The diagnosis was confirmed by immunohistochemical study. The patient had multiple, subcutaneous, painless lipomas localized in the arms, forearms, thighs, abdomen and thorax. Because of the family history and the clinical presentation the disease was determined as familial multiple lipomatosis (FML). We performed radical tumor resection with distal pancreatectomy and splenectomy, and abdominoplasty, removing redundant skin and underlying subcutaneous fat tissue with multiple lipomas. Discussion FML is a rare hereditary benign disease. On the other hand, only few cases with familial GIST have been reported. In cases with extensive abdominal involvement, the primary origin of EGIST may be impossible to determine so the differential diagnosis is very difficult. Conclusion Although we could not prove correlation between the observed diseases, they are extremely rare and their combination is unusual which makes the presented case valuable and interesting. [ABSTRACT FROM AUTHOR]

Fibrous dysplasia occurs rarely in the spine, especially in the thoracic spine. According to the literature, less than 20 cases have been reported. We report in this paper a 48-year-old female patient with fibrous dysplasia of the first thoracic spine and left side of the first rib with left thoracic first root compression. She complained of severe pain of the left arm, numbness on the ulnar side of the left forearm, and weakness of the middle to little fingers. Computed tomography and magnetic resonance imaging showed the characteristic appearance of fibrous dysplasia, which includes ground-glass opacity, an expansile nature, and lytic lesions with sclerotic rims. She underwent surgical intervention with radical tumor resection combined with stabilization and fusion with a mesh graft. The pain was relieved. The thoracic first root compression signs improved after the operation. Nineteen months after the operation, there was no recurrence of the tumor. We suggest that radical tumor resection combined with stabilization and fusion with an anterior or posterior approach using a mesh graft for thoracic fibrous dysplasia can achieve definite decompression and prevent tumor recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of this study was retrospectively to identify tumor characteristics or any other prognostic factors that influence disease survival after curative rectal cancer resection. Patients and Methods: The records of 95 patients with Stages I, II, or III rectal cancer (TNM system) seen from August 2008 to June 2012 in one institution were reviewed. The patients underwent radical surgery (abdominoperineal resection or laparoanterior resection with lymph node dissection) as definitive therapy and then adjuvant treatment if pathology indicated T3 or T4 lesions, lymph node involvement, or positive margins. Radiation therapy (54 Gy) was delivered to the gross tumor volume and 45–50 Gy to the nodal region. The chemotherapy protocol consisted of 12 biweekly courses of oxaliplatin (85 mg/m2), 5-fluorouracil (FU) (400 mg/m2), and leucovorin (400 mg/m2) on Day 1, followed by continuous infusion of 5-FU (2400 mg/m2) for 48 hours. Results: The 3-year cumulative overall survival rates for Stages I, II, and III rectal cancer were 100%, 100%, and 75%, respectively. Univariate analysis for all 91 patients indicated that pN classification, stage, surgical margin ≤ 10 mm, and extracapsular spread (ECS) were significantly associated with overall survival. The pN classification and stage also significantly affected the disease-free survival and distant metastasis-free survival. Furthermore, univariate analysis indicated vascular permeation, neural invasion, and surgical margin ≤ 10 mm were significantly associated with disease-free survival. Vascular permeation also significantly affected distant metastasis-free survival. On multivariate analysis for all patients, pN classification and close surgical margin significantly affected disease-free survival. Conclusion: The presence of lymph node involvement and close margins was associated with lower disease-free survival. More aggressive postoperative therapy is suggested for patients if these factors exist. [Copyright &y& Elsevier]

Fibrous dysplasia (FD) is a non-neoplastic developmental disease of bone characterized by replacement of normal bone by immature bone and osteoid in a cellular fibrous matrix. FD affecting the cranial base is often challenging to treat because of the proximity to neurovascular and ocular structures.This is a retrospective study comprising 32 patients diagnosed with FD involving the anterior cranial base during a 9-year period. From these cases, 26 patients were surgically treated at the Department of Otorhinolaryngology, Alexandria University. The remaining 6 patients refused surgical treatment and were followed up. The follow-up period ranged from 1.5 to 9 years (mean, 4.6±2.1 y).The most common symptoms were headache (75%), nasal obstruction (65.6%), and proptosis (59.4%). The most frequently involved bone was the ethmoid (93.8%), followed by the sphenoid (68.8%). Out of the 32 patients, 6 patients refused surgical treatment and were followed up. Among the 26 patients who underwent surgery, 15 underwent radical excision, and in the remaining 11 cases the resection was considered subtotal. None of the patients who had radical resection developed any regrowth of their lesions. Three of the 11 patients who had subtotal resection demonstrated radiologic evidence of regrowth.In most cases of FD involving the anterior cranial base, accurate preoperative radiologic planning and modern surgical techniques with immediate reconstruction allow an aggressive but definitive treatment with good functional and aesthetic results. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Ameloblastoma is rare worldwide. Delayed treatment can result in significant morbidity from facial deformity and infiltration of adjacent tissues. Mortality can occur from invasion of vital structures in the head and neck, super infection, recurrent and even distant metastases. Recurrence after radical treatment is not common. Case report: This paper presents a case of soft issue recurrence in the chin 21 years after radical resection of the mandible for ameloblastoma. The iliac crest bone grafted to the site was not involved in the tumour recurrence. Conclusion. Radical surgical resection is accepted treatment for solid/multicystic ameloblastoma. However, the surgical review should be for life as recurrence can occur after a long interval. [Copyright &y& Elsevier]

Abstract: Introduction: Classically defined cystic duct carcinoma is extremely rare owing to its strict diagnostic criteria, which are not suitable in actual clinical settings. Recently, several new classifications of cystic duct carcinoma were reported, which defined it as a tumor with its center located in the cystic duct. On the other hand, the incidence of cystic duct carcinoma, based on the new classifications, is not rare, but all reported cases are advanced. Presentation of case: A 77-year-old man with dilatation of the common bile duct, a stricture at the level of the cystic duct junction, and a filling defect of contrast medium into cystic duct in endoscopic retrograde cholangiopancreatography was diagnosed with cystic duct carcinoma. Radical cholecystectomy with bile duct resection was performed. In the resected specimen, we found that a 2cm tumor whose center was located in the cystic duct and vertically limited to the mucosal layer. Horizontally, the tumor was superficially spread in the gallbladder, which were also limited to the mucosal layer. Discussion: Here we report a first case of early cystic duct carcinoma diagnosed according to a new classification that had spread superficially into the gallbladder. When treating an early cystic duct carcinoma, it is important to note that even localized carcinoma can potentially invade into adjacent organs or metastasize to regional lymph nodes due to the location of cystic duct. Conclusion: It is suggested that perform radical resection such as cholecystectomy with gallbladder fossa resection, extrahepatic bile duct resection and regional lymphadenectomy is the treatment of choice. [Copyright &y& Elsevier]

Background and objective Video-assisted mini-thoracoscopy (VAMT) has been used for pulmonary lobectomy for 20 years, which has many merits including small wound, less pain and quick recovery. VAMT is the tendency of pectoral minimally invasive surgical treatment. The aim of this study is to evaluate the efficacy of video-assisted mini-thoracoscopy (VAMT) for radical resection of pleomorphic carcinoma of the lung. Methods Complete resection of pleomorphic carcinoma of the lung was performed on 28 patients by VMAT. A 1.5 cm and a 6 cm to 8 cm incision was made during the operation. Both standard surgical instruments and thoracoscopic set were used to treat the pulmonary vessels, perform lobotomy, and remove the lymph nodes in the mediastinum and pulmonary portal. Results The operation was completed in all of the cases. No peri-operative death occurred. The total volume of hemorrhage was 200 mL to 450 mL (mean, 300 mL). The patients received chest drainage for 3 to 8 days after the operation (mean, 5 d). The time in hospital was 7 d-14 d (mean, 12 d). Five-year overall survival and disease-free survival were 39.2% and 47.1%, respectively. Follow-up was available in all 28 patients for up to 2 to 91 months. Among the 28 cases, only 2 patients died 2 months after the operation, the rest all live up over 1 year. 3-year survival rate was 60.7% (95%CI: 40.3%-81.1%). Conclusion VAMT is effective for radical resection of pleomorphic carcinoma of the lung in a short term. Combination the superiority of traditional procedure and VATS, so VAMT is safe and reliable for radical resection of pleomorphic carcinoma of the lung. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To review the experience with hilar cholangiocarcinoma and to determine the results of a radical surgical approach in a UK centre. Methods: A 10-year review of all patients treated surgically for proximal bile duct carcinoma at a single surgical unit was conducted. Patient demographics, disease details and histopathology reports were reviewed. From January 1993 through December 2003, 106 patients were admitted with the diagnosis of hilar cholangiocarcinoma and 61 patients received surgical exploration. Results: Tumours were staged as follows (UICC 6th edition): stage IB, n =10 IIA, n =9; IIB, n =20; III, n =8; IV, n =14. Out of 61 patients, 44 had a resection (3 bile duct resection alone, 41 liver resection with bile duct resection), 5 were considered unresectable and 12 underwent liver transplantation (LT). The caudate lobe was excised in 34 of the patients and regional lymphadenectomy was systematically carried out. Para-aortic lymphadenectomy was performed in 17 cases. Portal vein resection was needed in 17 and hepatic artery resection was performed in 4 cases. Negative histologic margins (R0) were achieved in 20 patients and microscopic margin involvement (R1) was seen in 16. In the remaining 8 resected patients, localised metastasis were found (peritoneal deposits in 2, liver metastasis in 4 and positive para-aortic lymph nodes in 2); nevertheless the resection was performed and it was considered R2. Overall survival at 3 and 5years for patients who underwent a resection was 43% and 28% including postoperative deaths. The 1-, 3- and 5-year actuarial survival rates for patients who underwent R0 resection were 78%, 64% and 45% respectively, including the postoperative deaths (n =3). The median survival time was 41.1months. The 1-, 3- and 5-year actuarial survival rates for R1 resection and R2 were 60%, 26%, 26% and 25% and 0% respectively, while the median survival time for these groups was 15.4 and 6.8months respectively. The actuarial survival rate at 1, 3 and 5years for well-differentiated tumours (G1) was 73%, 54% and 40% (median 39.7months). The figures for G2 were 60%, 48% and 0%. The figures for G3 (poorly differentiated) were 16% and 0% at three years (p =0.03).The overall survival at 3 and 5years for those patients who had a liver transplant was 41% and 20% including early postoperative mortality. The tumour grading (presence of poorly differentiated tumour) was found to be the only independent factor affecting the survival time producing a hazard ratio of 4.3 (p =0.0034, 95% confidence interval 0.1007–6.342). Conclusions: Radical surgical resection is the best treatment for hilar cholangiocarcinoma. R0 resection provides acceptable 5-year survival, but R1 resection may also provide acceptable palliation. In our experience TNM stage and tumour grade were the main determinants of long-term survival. [Copyright &y& Elsevier]

Summary: We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively. [Copyright &y& Elsevier]

PURPOSE: Local excision for early-staged rectal cancers is controversial. Preoperative understaging is not uncommon and radical resection after local resection may be needed for a curative treatment. The aim of this study was to determine the frequency and outcome of radical resection (within 30 days) after local excision for rectal adenocarcinoma. METHODS: All locally excised rectal cancers (curative intent) that required radical surgery within 30 days were reviewed (1980-2000). T2-3N0-1 stage cancers were each matched to three primary radical surgery controls for stage, age (±5 years), gender, date (±1 years), and type (abdominoperineal resection or low anterior resection) of operation. T1N0-1 cancers were compared with stage-matched rectal cancers treated by either primary radical surgery (n = 78) or local excision alone (n = 77). RESULTS: Fifty-two locally excised rectal adenocarcinomas (29 transanal and 23 polypectomies) were followed by radical surgery (24 abdominoperineal resection and 28 low anterior resection) within 7 (range, 1-29) days. Radical surgery was performed because of a cancerous polyp (n = 42), positive margins (5), lymphovascular invasion (3), and T3-staged cancer (2). Twelve of 52 cancers (23 percent) were found to have nodal involvement and 15 of 52 (29 percent) showed residual cancer in the resected specimen. The T2-3N0-1 stage controls were well matched. No significant difference in tumor location, size, adjuvant therapy, or length of follow-up was noted. Local and distant recurrence occurred in 2 of 4 T2-3N1 tumors and in 2 of 11 T2-3N0 cancers and were comparable to the matched controls, as was survival, with the exception of shorter survival in T3N1 cases, but numbers were too small for a definitive conclusion. Length of follow- up was not different. For Ti cancers, the controls were also comparable regarding patient and tumor demographics and adjuvant therapy. Nodal involvement was 21 percent in T1 study cases and 15 percent in T1 primary radical-surgery controls, with a trend toward location in the lower third of the rectum in both groups (58 percent and 50 percent, respectively). Local recurrence rates were 3 percent in the study group, 5 percent for patients undergoing primary radical surgery, and 8 percent for local excision alone. Distant metastasis (11 percent, 12 percent, and 13 percent, respectively) and overall five-year survival were also not significantly different (78 percent, 89 percent, and 73 percent, respectively). CONCLUSIONS: Nodal involvement in attempted locally excised rectal cancers is not uncommon. Local excision of rectal tumors followed by radical surgery within 30 days in cancer patients does not compromise outcome compared with primary radical surgery. Even after radical surgery for superficial T1 rectal cancers, recurrence rates are not insignificant. Future improvements in preoperative staging may be helpful in selecting tumors for local excision only. [ABSTRACT FROM AUTHOR]