Introduction: Nowadays laparoscopic surgery is a very common form of treatment strategy for digestive diseases and these ‘keyhole’ surgeries provide many benefits to the patients. However, controversy exists when the laparoscopic surgery is done for early gallbladder cancer. The aim of our study was to report two such cases to see feasibility and safety of laparoscopic radical cholecystectomy with lymph node dissection.
Case Series: Two patients underwent laparoscopic radical cholecystectomy with lymph node dissection for gallbladder carcinoma. Both patients were preoperatively diagnosed. Mean operative time was 172 minutes, and average estimated blood loss was 225 ml. There was no intraoperative complication. The liver dissection was done by Harmonic in one case and by Waterjet in the other case. Average hospital stay after surgery was four days. Postoperative morbidity included minimal bile leak in one patient only and no bile leak in patient operated with Waterjet system. Postoperative histopathology revealed adenocarcinoma of gallbladder with no lymph node invasion T2N0M0 (Stage II) in both patients. The mean lymph node retrieval was 5.5. Both patients received adjuvant chemotherapy with gemcitabine and carboplatin.
Conclusion: We conclude that laparoscopic radical cholecystectomy with lymph node dissection is safe and beneficial for the patients with T1b/T2 gallbladder carcinoma and is useful in selected patients with a preoperative suspicion of early-stage gallbladder cancer by sparing them the necessity of a second-stage open procedure.
7 year old symptomatic girl was diagnosed with gall bladder polyp on ultrasonography and MRCP (magnetic resonance cholangiopancreatography). Laparoscopic cholecystectomy was performed and patient was discharged on 2 post operative day without any complications. Histopathology and Immunohistochemistry revealed pyloric gland adenoma with squamoid morules. Gall bladder polyps are seen in 5% of the adult population around the world but rarely seen in children. Polyps have the potential to convert into malignancy and hence early diagnosis and differentiation is necessary.Most of the patients with gall bladder adenomas are adult females. Majority of the adenomas (91%) are single. Squamoid morules was found in 28% and columnar oxyphil cells in 2% of these adenomas. High-grade dysplasia/carcinoma in situ was seen in 27% of them and low-grade dysplasia in 15%. However, only 1% invasive adenocarcinomas were diagnosed in pyloric gland adenomas, both of which were intestinal type. For symptomatic patients who have pain and dyspepsia, cholecystectomy is the recommended treatment. For asymptomatic or incidentally detected patients, the indications for cholecystectomy should be age more than 50 years, solitary polyp greater than 10mm in largest dimension, accompanying gall stones and increase in size on serial sonographies.As per our knowledge the case we report is the first case of gallbladder pyloric adenoma with squamoid morules in pediatric age group. Treatment with simple cholecystectomy is recommended in view of literature suggesting pre malignant lesion.
Objectives:The pattern of metastasis in the neck nodes and associated clinical factors in patients with oral cavity cancer were the subjects of this research, and their patterns were evaluated. Materials and Methods: Patients with oral squamous cell carcinoma (OSCC) who did not have a history of other cancers and who were not currently undergoing neo-adjuvant concomitant chemo-radiotherapy or radiotherapy were chosen for research. In total, 300 patients met these criteria. Results: 109 out of 300 instances of oral squamous cell carcinoma patients with clinically and radiologically N0 neck had microscopic evidence of metastatic lymphadenopathy. There is a possibility of metastases in level IIb, but they are much more common in levels IB, III, and IV. Positive nodes on level IIB were correlated with three positive nodes on level IIA.
Conclusion:During the follow-up, there was a substantial correlation between the size of the primary tumor and the number of distant metastases.
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