Background. Laparoscopic splenectomy (LS) is considered the operation of choice on elective basis for managing patients with certain hematological disorders. Hemostatic control of the splenic pedicle is one of the crucial steps in LS. This study compares the safety and efficacy of using endoscopic staplers and vessel sealing devices to control the splenic pedicle in patients with nonsevere splenomegaly. Methods. Fifty-one consecutive patients with different blood disorders including idiopathic thrombocytopenic purpura (ITP), hypersplenism, and lymphoma were randomized for elective LS. Traditional steps of LS, via lateral approach, were followed, and pedicle control was done with either endovascular gastrointestinal anastomosis stapler (n = 26) or vessel sealing device (Ligasure) (n = 25). Results. No difference was noted with different splenic spans when using either methods of pedicle control ( P = .145). The volume of blood loss was higher in the Ligasure group compared to the staplers group (182 mL vs 131 mL, respectively), but was not statistically significant ( P = .249). Conversion to open was notably higher in the Ligasure group ( P = .034), but the intraoperative complications were comparable in both groups ( P = .357). Conclusion. The use of vessel sealing devices for splenic pedicle control has comparable surgical outcomes compared with the use of endoscopic staplers for LS, but with higher rate of conversion to open surgery.
AimPleomorphic adenoma is the most common benign tumor of the parotid gland and is classically treated with superficial or total parotidectomy. Less radical surgeries have been proposed to minimize the risk of facial nerve injury. The oncological safety of these procedures remains controversial. We conducted this study to evaluate the safety of superficial hemi-lobectomy (quadrantectomy).Patients and methodsRetrospective analysis was conducted on the paraffin sections of archived superficial parotidectomy specimens from 11 male and 6 female patients (median age 33 years). The microscopic extent of extra-capsular extension was determined on pathological revision. In addition, prospective evaluation of 12 quadrantectomy procedures (M/F = 7/5, median age = 36 years) compared to 24 radical surgeries (M = F, median age = 40 years) regarding temporary and persistent facial nerve dysfunction on routine clinical assessment and recurrence rate.ResultsOn retrospective pathological revision, pleomorphic adenomata had a median microscopic spread of 3 mm beyond capsule in paraffin sections (SD = 3.6). On prospective analysis with a median follow-up of 33 months (range = 18–54 months), quadrantectomy had similar relative risk of temporary facial nerve dysfunction evaluated at the immediate postoperative period as well as persistent nerve dysfunction assessed at 3 months (P = 0.701 and P = 0.902, respectively). Of the whole study population, one case of recurrence after total parotidectomy was observed at mid-term follow-up (P = 1.000).ConclusionParotid quadrantectomy is a safe management for smaller pleomorphic adenomata localized close to one of the two divisions of the facial nerve.
Background: Numerous hepatocellular carcinoma (HCC) biomarkers have been assessed in the diagnosis and prognosis of HCC. The aim of this study was to assess the value of α-fetoprotein (AFP)-L3% and transforming growth factor B1 (TGFB1) as prognostic markers in hepatocellular carcinoma after radiofrequency ablation (RFA). This observational cohort study included 40 patients with HCC diagnosed by triphasic computed tomography criteria indicated for radiofrequency ablation. Serum AFP, AFP-L3%, and TGFB1 were measured in all patients before and 3 months after radiofrequency ablation. Results: Statistically significant lower levels of TGFB1, AFP, and AFP-L3% were noted in the HCC patients after radiofrequency ablation. Significant lower levels of TGFB1, AFP, and AFP-L3% were found in the no recurrence group in comparison to the recurrence group. The cutoff value of TGFB1 > 56.87 ng/mL, AFP > 74.9 ng/mL, and AFP-L3% > 8.5% was the best in the discrimination of tumor recurrence with sensitivity of 85.7%, 57.1%, and 100%; specificity of 54.6%, 84.9%, and 100%; and diagnostic accuracy of 64.5%, 69%, and 100%, respectively. Conclusion: TGFB1 and AFP-L3% are good prognostic markers for HCC. They could be used to monitor the response of HCC to treatment.
<i>Background:</i> Pancreatic cancer is the fourth most common cause of cancer related deaths in the world. Surgical resection remains the only potentially curative treatment for adenocarcinoma of the pancreas; only 10% - 20% of patients are candidate for standard pancreatic resection. <i>Objective:</i> To evaluate perioperative mortality, morbidity and survival for patients underwent PD in middle-volume center. <i>Patients and Methods:</i> Sixty patients with pancreatic tumors were enrolled in this study for different surgical procedure according to type of tumors. <i>Results:</i> No early postoperative complications were observed in 60% of patients, whereas 40% of patients developed one or more complication, the median survival for this group was 12.3 months with standard deviation 3.8 months
Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement. Several studies evaluated the accuracy of Sentinel lymph node biopsy in breast cancer patients post neoadjuvant chemotherapy. In this study, we will examine accuracy and feasibility of using Sentinel lymph node biopsy in predicting axillary lymph node status in breast cancer patients after neoadjuvant chemotherapy. Methods: 45 female patients with resectable, nonmetastatic breast carcinoma cases who received neoadjuvant chemotherapy were enrolled in this study according to the routine Mansoura Oncology Center-guidelines of management of breast cancer. Methylene blue dye used for detection of Sentinel lymph node. Results: Successful Sentinel lymph node detection was 82.2%. Skin involvement (T4 disease) were linked to a low identification (P = 0.005). False negative rate equals 11/27 = (40.7%).With advancement of the stage of the tumor, the incidence of false negative results increases significantly (p = 0.012) with 95% confidence interval; 1.2 -5.4. Conclusion: Sentinel lymph node should be adopted to be the standard method for axillary staging with T1-3 tumors after receiving neoadjuvant chemotherapy, in T4 patients, it is associated with low detection rate & high false negative rate making it doubtful technique for axillary staging.
Background: Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC) owing to the survival advantage, which has correlated with down-staging of the cancer to pT0. This approach is underused because it may be associated with increased perioperative morbidity and mortality rates. This study was designed to evaluate NAC plus RC regarding pathological response, perioperative morbidity and mortality outcomes. Methods: This is a prospective study that was carried out from August 2015 till July 2017 for patients with bladder carcinoma. We enrolled all cases with ≥ T2 bladder receiving NAC. Patients with metastatic disease, poor performance were excluded from this study.Results: pathological response rate and Complications occurred within 30 and 90 d after surgery. Heterologous blood transfusions, length of stay, readmission, and perioperative morbidity, and mortality were compared.Conclusions: Our results suggest that non-urothelial tumor showed no response to Platinum based combination chemotherapeutic regimens. NAC followed by RC gives no more perioperative complications.
Urinary bladder leiomyoma is a rare tumour accounting for less than 0.5% of all urinary bladder tumours. Till now, less than 250 cases were documented with variable sizes, most of them were less than 10 cm in maximum diameter. Here we present a 68- year-old female patient with urinary bladder giant leiomyoma measuring about 13 cm. She presented with right loin pain. Postcontrast computed tomography of the abdomen and pelvis revealed a large posterolateral right-sided urinary bladder mass with moderate right hydroureteronephrosis. It was managed by partial cystectomy. The patient had an uneventful postoperative course. Postoperative pathological examination of the specimen confirmed giant leiomyoma of the urinary bladder.
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