ratory data showed a white blood cell count of 9 800 / mm 3 (normal 3 500 -9 000) with a mild left shift, a C-reactive protein level of 0.15 mg / dl (normal, < 0.17) and a creatine kinase level of 123 IU / I (normal, 62 -287). The diagnosis was sigmoid colon volvulus and the patient underwent colonoscopic decompression. He was discharged and was followed up on an outpatient basis. A similar event occurred 6 months later, and he underwent colonic decompression followed by elective laparoscopic sigmoidectomy after complete bowel preparation. The patient was placed in the lithotomy position, and a 5-mm trocar for the laparoscope was inserted through a sub-umbilical incision, while the other three 5-mm trocars were inserted in the right upper, right lower, and left upper quadrants along the mid-clavicular line, respectively, and CO 2 gas was then insuffl ated at pressure of 8 mmHg. An elongated sigmoid colon with moderate dilatation was seen, with a long narrow-based mesentery and close approximation of the two limbs of the sigmoid loop. After simple fenestration of the sigmoid mesentery, a balloon catheter was introduced into the sigmoid colon through the anus, and the sigmoid colon was then tied tightly with umbilical tape just below the insuffl ated balloon. The catheter was carefully pulled out, creating a rectosigmoid prolapse ( • ▶ Fig . 2a,b ). The colon was transected at the rectosigmoid junction, the divided sigmoid colon was exteriorized via the anus, and the redundant part was resected with dissection of the arcade and straight vessels ( • ▶ Fig . 2c ). The detachable anvil
Background and Objectives: Although cholangiolocellular carcinoma is considered a combined hepatocellular and cholangiocarcinoma, we feel that this classification is not appropriate. Therefore, we compared the diagnostic imaging findings, surgical prognosis, and pathological features of cholangiolocellular carcinoma with those of other combined hepatocellular and cholangiocarcinoma subtypes, hepatocellular carcinoma, and cholangiocarcinoma. Methods: The study patients included 7 with classical type combined hepatocellular and cholangiocarcinoma; 8 with stem cell feature, intermediate type combined hepatocellular and cholangiocarcinoma; 13 with cholangiolocellular carcinoma; 58 with cholangiocarcinoma; and 359 with hepatocellular carcinoma. All patients underwent hepatectomy or living-related donor liver transplantation from 2001 to 2014. Results: cholangiolocellular carcinoma could be distinguished from hepatocellular carcinom, other combined hepatocellular and cholangiocarcinoma subtypes, and cholangiocarcinoma by the presence of intratumoral Glisson’s pedicle, hepatic vein penetration, and tumor-staining pattern on angiography-assisted CT. Cholangiolocellular carcinoma was associated with a significantly lower SUV-max than that of cholangiocarcinoma on FDG-PET. Hepatocellular carcinoma, classical type, and cholangiolocellular carcinoma had significantly better prognoses than stem cell feature, intermediate type and cholangiocarcinoma. A cholangiocarcinoma component was detected in cholangiolocellular carcinoma that progressed to the hepatic hilum, and the cholangiocarcinoma component was found in perineural invasion and lymph node metastases. Conclusions: From the viewpoint of surgeon, cholangiolocellular carcinoma should be classified as a good-prognosis subtype of biliary tract carcinoma because of its tendency to differentiate into cholangiocarcinoma during its progression, and its distinctive imaging and few recurrence rates different from other combined hepatocellular and cholangiocarcinoma subtypes.
Background: An inappropriate skin incision on the breast reduces the cosmetic benefit of breast-conserving surgery (BCS).
Methods: To improve the cosmetic outcome, we have performed “Moving window” operation in which BCS can be performed via a periareolar incision (periareolar approach) and/or axillary incision (axillary approach) under direct visualization. Axillary lymph node dissection is also performed via an axillary incision.
Results: Periareolar approach was performed in 65 patients and axillary approach in 43 patients. Average operation time was 130 minutes in periareolar approach and 131 minutes in axillary approach. Average blood loss was 37 mL and 50 mL, respectively. Postoperatively, the surgical margin of breast tissue was histologically confirmed to be negative in 107 (99%) of 108 patients, while two patients underwent reoperation because of positive surgical margin. Fifty-two patients (85%) in periareolar approach and 37 patients (86%) in axillary approach had excellent or good cosmetic results.
With a mean follow-up of 36 months, one patient with DCIS developed in-breast recurrence, while 3 patients who had neoadjuvant chemotherapy developed in-breast recurrence.
Conclusion: The moving window operation can improve a cosmetic outcome of the conserved breast without compromising the oncological safety.
Moreover, it can reduce operating time and blood loss when compared with the endoscope-assisted BCS.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-13.
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