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Bladder cancer is the 9th most frequent cancer worldwide. Its incidence is increasing. The pancreas is an infrequent site of metastasis in relation to any type of malignancy. In this study, we report our experience with a patient who has undergone a pancreaticoduodenectomy for metastatic bladder cancer. A 61-year-old male was admitted with jaundice and pancreas head mass. He underwent robot assisted-cystectomy and ileal conduit for bladder cancer 7 months ago. Initial diagnosis under the imaging study was a resectable pancreas head cancer. However, we did not rule-out a metastatic bladder cancer. He underwent a classic pancreaticoduodenectomy. Based on histologic findings and immunohistochemistry results, a pancreas tumor with 4.9-cm sized metastatic urothelial carcinoma was diagnosed. He experienced no complication. He was discharged 11 days after the surgery. Four cycles of gemcitabine and cisplatin were administered. He remained recurrence-free of tumors for 16 months. Although the benefit of pancreatectomy for patient survival has been reported for metastases from renal cell carcinoma, it is unknown for bladder cancer because of no report. We believe that curative resection for metastasis to pancreas of urothelial carcinoma might be helpful for its management.

Despite its limited benefits, operative site drainage after elective hepatectomy is routinely used. This study aimed to investigate the safety and effectiveness of left lateral sectionectomy without operative site drainage.This study retrospectively collected data from 31 patients who underwent elective left lateral sectionectomy between January 2017 and June 2020. Based on whether operative site drainage was used, the patients were divided into two groups: drainage and non-drainage of the operative site and a comparative analysis was conducted.A total of 31 patients underwent left lateral sectionectomy during the study period. Of these, 22 patients were diagnosed with hepatocellular carcinoma; three, with intrahepatic cholangiocarcinoma; three, with liver metastasis; and three, with benign liver disease. Ten patients underwent laparoscopy. No significant differences were observed between the open and laparoscopic surgery groups. In the univariate analysis, there were no significant differences in the pre-, intra-, and postoperative clinicopathological factors between the non-drainage and drainage groups. The hospitalization period in the non-drainage group was significantly shorter than in the drainage group (8.44 days vs. 5.87 days,Routine use of surgical drainage for left lateral sectionectomy of the liver to prevent intraperitoneal fluid collection is unnecessary.

Backgrounds/Aims This study aimed to evaluate clinical application of InnoSEAL Plus (a mussel-inspired catecholamine hemostat) as a new hemostatic material for humans. Methods Patients treated with topical hemostatic patches after liver resection were enrolled. They were divided into an experimental group (InnoSEAL Plus group) and two control groups (TachoSil® group and Surgicel Fibrillar® group) for efficacy evaluation. Results A total of 15 patients were enrolled. Each group had five patients. The 3-minute hemostasis success rate was 80.0% (4/5 patients) in the InnoSEAL Plus group, 80.0% (4/5 patients) in the TachoSil® group, and 40.0% (2/5 patients) in the Surgicel Fibrillar® group, showing no significant difference in the success rate among these groups (p > 0.05). All three groups exhibited 100% success rate for 10-minute hemostasis. Both InnoSEAL Plus and TachoSil® groups had one patient developing adverse events, which were treated easily with drug administrations. Conclusions InnoSEAL Plus is expected to be functionally not inferior to other conventional hemostatic agents. However, it is necessary to confirm this through multicenter prospective studies in the future.

Introduction Despite limited availability, prophylactic operative site drainage after elective hepatectomy has been used routinely. The objective of this study was to investigate the safety and effectiveness of nonuse of operative site drainage after left lateral sectionectomy. Methods Elective left lateral sectionectomy was performed 31 patients between Jan 2017 and June 2020. We retrospectively evaluate d data that were prospectively collected on left lateral sectionectomy. Patients were divided into drainage group (n = 16) and non-use group (n = 15). Results The patients included 22cases of hepatocellular carcinoma, 3cases of intrahepatic cholangiocarcinoma, 3cases of liver metastasis and 3cases of benign liver disease. Ten cases were performed by laparoscopic surgery. There was no difference between the two groups in clinicopathological factors and surgical outcomes such as incidence of surgical related complications. There was no case of intraperitoneal fluid collection requiring additional procedure after heaptectomy and early re-admission. But, in the period from surgery to discharge, the non-use group was significantly shorter than that of the drainage group (5.87 days vs. 8.44 days, p = 0.005). Conclusions We concluded operative site drainage is unnecessary after elective left lateral sectionectomy.

Introduction In ampullary adenocarcinoma cases, the clinical effects of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) have not yet been well-studied, unlike other prognostic factors that have been reported till date. This study aimed to investigate the clinical impact of maximum standardized uptake value (SUVmax) in predicting the prognosis of ampullary adenocarcinoma. Methods Thirty-eight patients who underwent preoperative 18F-FDG PET/CT and curative-intent resection of ampullary adenocarcinoma at Pusan National University Hospital (Busan, Korea) between 2008 and 2017 were retrospectively analyzed in this study. We evaluated the clinicopathologic outcomes according to the SUVmax using univariate and multivariate Cox proportional hazard regression analyses and receiver operating characteristic analysis to arrive at a cutoff value. Results Lymph node metastasis was detected in nine patients, and 15 patients experienced a recurrence during the follow-up period. Among 38 patients, 33 showed an increased FDG uptake by the main tumor. SUVmax of 4.55 (sensitivity 61.5% and specificity 60.0%) was selected as a significant predictive factor for advanced lesions (larger size, p = 0.02; advanced T stage, p = 0.02; node metastasis, p = 0.01; and lymphovascular invasion, p = 0.04). Patients with SUVmax under 4.55 exhibited significantly longer overall survival than the rest (< 4.55 vs. ≥ 4.55), and the 5-year overall survival was 82.8% vs. 57.4% (p = 0.05). Conclusions SUVmax of 4.55 on 18F-FDG-PET/CT could be a predictive factor for tumor biology and long-term survival in patients with ampullary adenocarcinoma. Nevertheless, considering the cost aspect and its limited prognostic effect, this study seems to require more patients.

Introduction Laparoscopic central bisectionectomy is still an area of great challenge and technically requiring surgery due to high incidence of surgical complication and poor intraoperative outcomes. We report our experience totally laparoscopic central bisectionectomy for colorectal cancer liver metastasis (CRLM) using indocyanine green (ICG) fluorescence imaging. Methods The patient was 77-years-old man and was performed laparoscopic low anterior resection with ileostomy, cholecystectomy for rectal cancer 3 years before admission. He diagnosed metachronous CRLM and on magnetic resonance imaging, 5 cm sized hepatic mass was shown between segment 4 and 8 with middle hepatic vein (MHV) involvement. During operation, the Cavitron Ultra Sonic Aspirator® and Sonicision™ (Medtronic) was applied for hepatic parenchyma dissection. For resection of major glissonian pedicle and MHV, Signia™ staple (Medtronic) was used. After right anterior glissonian pedicle was isolated and temporary clamping, 2.5 mg ICG was injected intravenously. The ICG stained area could be recognized, and subsequent parenchyma dissection was completed successfully under Pringled maneuver. Specimen was retieved via extended umbilical port site. Results The operation time was 205 minutes and the estimated blood loss was 300 mL. No transfusion was done intraoperatively and postoperatively. There was no significant complication after surgery. Computed tomography was checked on postoperative day 5, showed no abnormal pathologic findings. On pathologic findings, metastatic adenocarcinoma sized 5.4 cm with clear resection margin was diagnosed. The patient discharged on postoperative day 7. Conclusions Laparoscopic central bisectionectomy is safe and feasible compared with conventional open surgery. ICG imaging system is effective and helpful for safe hepatic resection.

Introduction Neuroendocrine neoplasm of extrahepatic bile ducts are very rare. The aim of this study to elucidate the clinicopathological characteristics, therapeutic approach and prognosis of these patients. Methods The subjects were 16 patients who were diagnosed with neuroendocrine neoplasm or mixed adenoneuroendocrine carcinoma (MANEC) after curative resection. There were 8 ampulla of Vater and 8 non ampulla of Vater (6 gallbladder and 2 distal bile duct). Results The female to male ratio was 1.3/1 with mean age of 57.9 years (ranging from 36 to 74 years). There were 8 cases of incidental diagnosis in health screenings and 2 cases during evaluation for other disease. The most common symptoms were abdominal discomfort (3 pain and 1 dyspepsia) and jaundice (2 cases). According to the 2010 WHO classification, 1 patient had NET G1, 5 NET G2, 6 NET G3 and 5 MANEC. G3 and MANEC were small cell type. Pancreatoduodenectomy was performed in 9 patients (1 combined minor hepatectomy), extended cholecystectomy in 6 cases (1 combined pancreaticoduodenectomy and right hemicolectomy) and radical bile duct resection in 1 case. There were no association between OS and DFS with various clinicopathological factors including TNM stage. Ki-67 (cut-off 20%) was only prognostic factor in OS (5-year survival: 100% vs. 42.3%; p = 0.044) and DFS (5-year survival: 100% vs. 47.6%; p = 0.059). Conclusions In NET of extrahepatic bile duct, the titer of Ki-67 is more important than TNM according to AJCC, and attention of Ki-67 titer may be needed in treatment of recurrence.

Renal cell carcinoma (RCC) is the most common type of kidney malignancy. The pancreas is an infrequent site of metastasis in relation to any type of malignancy. However, RCC is one of the tumor types that most frequently metastasize to the pancreas. In this study, we report our experiences with two patients who underwent pancreatic resection for metastatic RCC tumors; of these two patients, one patient had a tumor was a metachronous pancreas-only tumor, and the other patient's tumor was synchronous with hematogenous lung metastasis. Following left-side pancreatic resection, the patients were administered tyrosine kinase inhibitors.