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Giant hepatic extra-gastrointestinal stromal tumor treated with cytoreductive surgery and adjuvant systemic therapy:A case report and review of literature

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World Journal of Gastrointestinal surgery 2021年第3期13卷 315-322页

作者： Michel Ribeiro Fernandes Caroline Lorenzoni Almeida Ghezzi Tomaz J M Grezzana-Filho Flávia Heinz Feier Ian Leipnitz Aljamir Duarte Chedid Carlos Thadeu Schmidt Cerski Marcio Fernandes Chedid Cléber RositoPinto Kruel department of Gastrointestinal surgery and Transplantation Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007RSBrazil Division of Radiology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903RSBrazil department of Pathology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007RSBrazil

BACKGROUND Primary extra-gastrointestinal stromal tumors(E-GIST)of the liver are *** clinical presentation may range from asymptomatic to bleeding or manifestations of mass *** surgery followed by adjuvant therapy with imatinib is the standard of ***,under specific circumstances,a cytoreductive approach may represent a therapeutic *** describe herein the case of an 84-year-old woman who presented with a tender,protruding epigastric *** computed tomography scan revealed a large,heterogeneous mass located across segments III,IV,V,and VIII of the *** initial approach was transarterial embolization of the tumor,which elicited no appreciable *** the large size and central location of the tumor and the advanced age of the patient,non-anatomic complete resection was *** to substantial intraoperative bleeding and hemodynamic instability,only a near-complete resection could be *** and immunohistochemical staining confirmed the diagnosis of primary E-GIST of the *** the risk/benefit ratio for therapeutic options,debulking surgery may represent a strategy to control pain and prolong *** SUMMARY Here,we present a case report of a patient diagnosed with E-GIST primary of the liver,which was indicated a cytoreductive surgery and adjuvant therapy with *** E-GIST primary of the liver is a rare conditional,the treatment is with systemic therapy and total resection ***,a cytoreductive surgery will be necessary when a complete resection is no possible.

关键词： Extra-gastrointestinal stromal tumor Primary gastrointestinal stromal tumor of the liver Cytoreductive surgery debulking surgery Case report

Robotic surgery techniques to approach benign prostatic hyperplasia disease:A comprehensive literature review and the state of art

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Asian Journal of Urology 2021年第1期8卷 81-88页

作者： Marcio Covas Moschovas Frederico Timo´teo Leonardo Lins Ose´as de Castro Neves Kulthe Ramesh Seetharam Bhat Vipul R.Patel department of Robotic surgery AdventHealth Global Robotics InstituteFLUSA Faculdade de Medicina do ABC Sa˜o PauloBrazil

Objective:The robotic-assisted approach to simple prostatectomy(RASP)was conceived,essentially reproducing the fundaments of open simple *** the first report,RASP underwent several technical *** study aims to identify and describe the current robotic surgery techniques to approach benign prostatic hyperplasia(BPH).Methods:The paper performed a non-systematic literature review accessing PubMed and Embase databases for all full-text articles published from 2008 to May 2020,assessing robot-assisted surgical techniques for BPH treatment using the terms“robot-assisted simple prostatectomy”OR“robotic simple prostatectomy”OR“RASP”AND“surgical technique”.Results:After careful review of 180 studies in PubMed and 198 in Embase,16 papers reporting different RASP *** the first procedure described by Sotelo et al.[9],several authors contributed to the development of the RASP *** et al.[24]proposed the extraperitoneal access,and Yuh et al.[23]first reported the adenoma transcapsular *** modifications were proposed by Coelho et al.[31]on trigonization,posterior reconstruction,and urethro-vesical *** groups focused on urethral-preserving *** et al.[28]and Clavijo et al.[32]recently described an intrafascial RASP with the removal of the entire prostatic ***,Kaouk et al.[29]reported the feasibility and safety of the da Vinci Single Port ***:In the last eighteen years,the robotic-assisted approach to BPH disease has been evolved,and different techniques have been *** review details all the technical developments on RASP that distinctive groups have proposed since the multiport robotic platforms until the new da Vinci Single Port.

关键词： Simple prostatectomy Benign prostatic hyperplasia Robotic-assisted Minimally invasive

Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess:Is it worth it?

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World Journal of Hepatology 2017年第2期9卷 114-118页

作者： Aylhin J Lopez-Marcano Jose M Ramia Vladimir Arteaga Roberto de la Plaza Jhonny D Gonzales Anibal Medina Hepato-Pancreato-Biliary Surgical Unit Department of SurgeryHospital Universitario de Guadalajara19002 GuadalajaraSpain

AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.

关键词： Hydatidosis Review surgery Abscess Liver

Survival benefit in patients after palliative resection vs non-resection colon cancer surgery

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World Journal of Gastroenterology 2006年第41期12卷 6634-6638页

作者： A Beham M Rentsch K Püllmann L Mantouvalou H Spatz HJ Schlitt A Obed department of surgery University of RegensburgGermany

AIM: To evaluate survival in patients undergoing pallia- tive resection versus non-resection surgery for primary colorectal cancer in a retrospective analysis. METHODS: demographics, TNM status, operating de- tails and survival were reviewed for 67 patients under- going surgery for incurable colorectal cancer. Palliative resection of the primary tumor was performed in 46 cases in contrast to 21 patients with non-resection of the primary tumor and bypass surgery. Risk factors for post- operative mortality and poor survival were analyzed with univariate and multivariate ***: The two groups were comparable in terms of age, gender, preoperative presence of ileus and tumor stage. Multivariate analysis showed that median survival was significantly higher in patients with palliative resec- tion surgery (544 vs 233 d). Differentiation of the tumor and tumor size were additional independent factors that were associated with a significantly poorer survival rate. CONCLUSION: Palliative resection surgery for primary colorectal cancer is associated with a higher median survival rate. Also, the presence of liver metastasis and tumor size are associated with poor survival. Therefore, resection of the primary tumor should be considered in patients with non-curable colon cancer.

关键词： Palliative surgery Colorectal cancer

Modelling the probability of erroneous negative lymph node staging in patients with colon cancer

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Cancer Communications 2019年第1期39卷 293-302页

作者： Carlos Fortea-Sanchis Erica Forcadell-Comes David Martínez-Ramos Javier Escrig-Sos Division of Colorectal surgery Department of SurgeryConsorci Hospitalari Provincial de CastellóCastellóSpain Oropesa Health Center Carrer de Torreblanca1412594 OropesaCastellóSpain department of surgery Hospital General de CastellóCastellóSpain

Background:Patients in who with insufficient number of analysed lymph nodes(LNs)are more likely to receive an incorrect LN *** ability to calculate the overall probability of undiagnosed LN involvement errors in these patients could be very useful for approximating the real patient prognosis and for giving possible indications for adjuvant *** objective of this work was to establish the predictive capacity and prognostic discriminative ability of the final error probability(FEP)among patients with colon cancer and with a potentially incorrectly-staged LN-negative ***:This was a retrospective multicentric population study carried out between January 2004 and december *** used a mathematical model based on Bayes’theorem to calculate the probability of LN involvement given a FEP test *** sum graphs were used to calculate risk groups and the survival rates were calculated,by month,using the Kaplan-Meier ***:A total of 548 patients were analysed and classified into three risk groups according to their FEP score:low-risk(FEP15%).Patients with LN involvement had the lowest overall survival rate when compared to the three risk *** difference was statistically significant for the low-and intermediate-risk groups(P=0.002 and P=0.004,respectively),but high-risk group presented similar survival curves to pN+group(P=0.505).In terms of disease-free survival,the high-risk group presented similar curves to the intermediate-risk group until approximately 60 months’follow-up(P=0.906).After 80 months’follow-up,the curve of high-risk group coincided with that of the pN+group(P=0.172).Finally,we summarized the FEP according to the number of analysed LNs and accompanied by a contour plot which represents its calculation ***:The application of Bayes’theorem in the calculation of FEP is useful to delimit risk subgroups from among patients without LN i

关键词： Colon cancer Lymph node staging Bayes’theorem Final error probability Prognosis

Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

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World Journal of Gastroenterology 2005年第30期11卷 4623-4627页

作者： Jun Ho Lee Junuk Kim Jae Ho Cheong Woo Jin Hyung Seung Ho Choi Sung Hoon Noh Research Institute and Hospital department of surgery

AIM： To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS： A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to december 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS： All but 12 patients were dassified as Child＇s class A. Only 35 patients （37.2%） were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy （77.7%） and 21 patients （22.3%） underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients （3.8%） who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients （39.4%） experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level （P = 0.011） and transfusion did （P = 0.008）. The most common postoperative complication was ascites （13.9%） followed by wound infection （10.6%）. CONCLUSION： We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

关键词： Gastric cancer Liver cirrhosis D2 lymph nodedissection Morbidity Mortality

Simultaneous Courvoisier's and double duct signs

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World Journal of Gastrointestinal Endoscopy 2017年第8期9卷 425-427页

作者： Shefali Agrawal Sandeep Vohra Hepatobiliary and Pancreatic surgery De-partment of Surgical OncologyIndraprastha Apollo Hospitals department of Radiology Indraprastha Apollo Hospitals

Presence of Courvoisier's or double duct signs in a jaundiced patient is suggestive of malignant obstruction of the pancreaticobiliary ductal *** oncologic impact of the simultaneous occurrence of these signs on the survival of patients with periampullary cancer is *** report a case of obstructive jaundice secondary to an ampullary cancer demonstrating the Courvoisier's sign on clinical examination and a double duct sign on *** patient underwent a pancreaticoduodenectomy which confirmed an ampullary adenocarcinoma.

关键词： Ampullary cancer Obstructive jaundice Double duct sign Courvoisier’s law Prognosis

From the mathematical model to the patient: The scientific and human aspects of artificial intelligence in gastrointestinal surgery

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World Journal of Gastrointestinal surgery 2024年第6期16卷 1517-1520页

作者： Javier Arredondo Montero department of Pediatric surgery Complejo Asistencial Universitario de LeónCastilla y LeónLeón 24008Spain

Recent medical literature shows that the application of artificial intelligence(AI)models in gastrointestinal pathology is an exponentially growing field,with pro-mising models that show very high *** inflammatory bowel disease(IBD),recent reviews demonstrate promising diagnostic and prognostic AI ***,studies are generally at high risk of bias(especially in AI models that are image-based).The creation of specific AI models that improve diagnostic performance and allow the establishment of a general prognostic fo-recast in IBD is of great interest,as it may allow the stratification of patients into subgroups and,in turn,allow the creation of different diagnostic and therapeutic protocols for these *** surgical models,predictive models of post-operative complications have shown great potential in large-scale *** this work,the authors present the development of a predictive algorithm for early post-surgical complications in Crohn's disease based on a Random Forest model with exceptional predictive ability for complications within the *** pre-sent work,based on logical and reasoned,clinical,and applicable aspects,lays a solid foundation for future prospective work to further develop post-surgical prognostic tools for *** next step is to develop in a prospective and mul-ticenter way,a collaborative path to optimize this line of research and make it applicable to our patients.

关键词： Survivor bias Data analysis Machine learning Ethics Critical thinking Postsurgical Complications Inflammatory bowel disease Gastrointestinal surgery

Psychiatric morbidity after surgery for inflammatory bowel disease:A systematic review

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World Journal of Gastroenterology 2017年第48期23卷 8651-8659页

作者： Marie Strom Zangenberg Alaa El-Hussuna Center for Surgical Science Department of SurgeryZealand University Hospital department of surgery Aalborg University Hospital

AIM To examine the evidence about psychiatric morbidity after inflammatory bowel disease(IBD)-related surgery. METHODS PRISMA guidelines were followed and a protocol was published at PROSPERO(CRD42016037600). Inclusion criteria were studies describing patients with inflammatory bowel disease undergoing surgery and their risk of developing psychiatric disorder. RESULTS Twelve studies(including 4340 patients) were eligible. All studies were non-randomized and most had high risk of bias. Patients operated for inflammatory bowel disease had an increased risk of developing depression,compared with surgical patients with diverticulitis or inguinal hernia,but not cancer. In addition,patients with Crohn's disease had higher risk of depression after surgery compared with non-surgical patients. Patients with ulcerative colitis had higher risk of anxiety after surgery compared with surgical colorectal cancer patients. Charlson comorbidity score more than three and female gender were independent predictors for depression and anxiety following surgery. CONCLUSION The review cannot give any clear answer to the risks of psychiatric morbidity after surgery for IBD studies with the lowest risk of bias indicated an increased risk of depression among surgical patients with Crohn's disease and increased risk of anxiety among patients with ulcerative colitis.

关键词： Inflammatory bowel disease General surgery Psychiatry depression Anxiety Postoperative complications