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Introduction: Although some studies have reported on the relationship between appendiceal stump closure methods and postoperative complications, there is no fixed method for this procedure. This study aimed to compare treatment outcomes of the existing procedures. Methods: We retrospectively analyzed the records of 200 patients who underwent urgent laparoscopic surgeries and investigated whether the difference in the appendiceal stump closure method was a risk factor for surgical site infection. The patients were divided into the Endoloop and endostapler groups, and 45 propensity score‐matched patients were included. The treatment outcomes of the two groups were compared. Results: The patients with high body temperature showed significantly developed surgical site infection in multivariate analysis (P =.036). There was no significant difference in the appendix stump methods (Endoloop vs endostapler). Regarding postoperative complications, superficial and deep incisional surgical site infection, organ/space surgical site infection, ileus, and complications of Clavien–Dindo grade IIIa or higher; there was no significant difference between the endoloop and endostapler groups after propensity score matching (P =.725, 1.000,.645 and.557, respectively). Conclusion: By properly using the Endoloop and endostapler according to the severity of inflammation, the Endoloop can be safely performed in many cases. Inexpensive Endoloop as an option for stump closure methods should positively impact medical costs. [ABSTRACT FROM AUTHOR]

Introduction: Despite the popularity of laparoscopic surgery, it remains unclear whether residual pneumoperitoneum influences the patient's postoperative course. This study aimed to evaluate the characteristics of residual pneumoperitoneum. Methods: This retrospective study included 201 Japanese patients who had undergone elective laparoscopic colorectal surgery. The patients were divided into groups, with and without anastomotic failure; the non‐anastomotic failure group was further divided into subgroups, with and without residual pneumoperitoneum. Patient characteristics were compared between the various groups. Results: The group with residual pneumoperitoneum included 57 patients (30.3%). Percutaneous drainage was required for one patient with residual pneumoperitoneum. Univariate analyses revealed that residual pneumoperitoneum was associated with low values for body mass index (BMI) and subcutaneous fat area (SFA). Furthermore, relative to the group with anastomotic failure, the group without anastomotic failure but with residual pneumoperitoneum had lower values for inflammatory markers. Conclusion: Low BMI and SFA values were identified as risk factors for residual pneumoperitoneum. Inflammatory markers may be useful as indicators for avoiding emergent surgery when it is difficult to differentiate between asymptomatic residual pneumoperitoneum and free air related to anastomotic failure. [ABSTRACT FROM AUTHOR]

Hepatic epithelioid hemangioendothelioma is a rare neoplasm with a variable malignant potential and a high risk of recurrence. No general treatment guidelines have been established. Fortunately, we were able to minimize immunosuppressant after liver transplantation because of a full HLA‐matched case. There was no recurrence 1 year after treatment. [ABSTRACT FROM AUTHOR]

Background/aim: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare subtype of primary liver carcinoma, characterized by the unequivocal presence of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). However, its clinicopathological characteristics have not yet been thoroughly elucidated. In particular, cholangiolocellular carcinoma (CLC) was classified as a subtype of cHCC-CCA according to the 2010 World Health Organization (WHO) classification. However, according to the 2019 WHO classification, tumors displaying histological features consistent with CLC but lacking evidence of hepatocellular differentiation should be regarded as a distinct subtype of iCCA. Nevertheless, there may be notable differences in prognosis between CLC and iCCA, indicating the necessity for refining the classification when devising clinical treatment strategies. This study aimed to determine the clinicopathological features and prognostic factors of cHCC-CCAs following radical resection., Patients and Methods: Between January 2010 and September 2020, based on the 2010 WHO classification, we retrospectively studied the clinicopathological features and prognoses of patients with cHCC-CCAs in relation to the pathological dominant classification. The patients were classified according to the pathological dominant components of cHCC-CCA as HCC-dominant (HCC-D), iCCA-dominant (iCCA-D), or CLC-dominant (CLC-D)., Results: Data of 55 patients who underwent primary radical hepatectomy for cHCC-CCA were analyzed. The prevalences of each dominant classification were HCC-D, 21 (38.2%); iCCA-D, 11 (20.0%); and CLC-D, 23 (41.8%). Multivariate analysis showed that dominant classification was an independent risk factor for recurrence and cancer-specific survival (CSS)., Conclusion: The dominant classification of cHCC-CCA has the potential to predict recurrence and CSS., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Purpose: Harvesting at least 12 lymph nodes (LNs) is recommended for adequate tumor staging in colon surgery. Although preoperative endoscopic tattooing has been used for primary localization of tumors, its impact on LN retrieval in colorectal surgery remains controversial. We aimed to investigate the relationship between preoperative tattooing and LN retrieval after laparoscopic rectal resection., Methods: We reviewed the records of 92 patients with rectal cancer who underwent laparoscopic resection from January 1, 2018 to December 31, 2019. Patients were categorized into 2 groups according to whether preoperative endoscopic tattooing was performed. The rate of adequate LN retrieval (≥12) was compared., Results: The tattooed and non-tattooed groups comprised 49 and 43 patients, respectively. In the tattooed and non-tattooed groups, the rates of adequate LN retrieval were 75.5% and 55.8%, respectively (P=0.046). Univariate analysis revealed that female sex, tattooing, LN metastasis status, pathological pathological stage (p-stage), and LN dissection were predictive factors for adequate LN retrieval. In the multivariate analysis, female sex (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.15-9.73; P=0.027), tattooing (OR, 2.87; 95% CI, 1.03-7.94; P=0.043), and p-stage (OR, 3.34; 95% CI, 1.04-10.75; P=0.043) were independent predictive factors for adequate LN retrieval after surgery., Conclusion: This study revealed that preoperative endoscopic tattooing was statistically significantly associated with adequate LN retrieval in patients with rectal cancer who underwent laparoscopic rectal resection. Preoperative endoscopic tattooing should be considered to improve disease assessment and avoid stage migration.

We evaluated the clinical outcome and assessed the safety of robot-assisted distal pancreatectomy(RADP)of early 5 cases in our institutional introduction. We followed the guidelines for introduction of robot-assisted pancreatectomy proposed by Japanese Society of Endoscopic Surgery. Patients' characteristics were 2 men and 3 women, 45-79(median 52) years old, and 3 patients with neuroendocrine neoplasm, 1 with intraductal papillary neoplasm and 1 with mucinous cystic neoplasm. Spleen-preserving RADP was performed in 2 cases. Clinical outcomes of 5 cases underwent RADP were, operation time was 308-437(median 330)minutes, blood loss was 5-270(median 100)mL and none received transfusion. Postoperative pancreatic fistula and postoperative complication more than Grade Ⅲa(Clavien-Dindo classification)were none. Postoperative hospital stay was 7-11(median 8)days. RADP in our institution was safely introduced by following the proposal of guidelines.