There were no significant differences in operative time, esti- mated blood loss, conversion rate, and number of harvested lymph nodes between the 2 groups. The day of first flatus was later in the elderly group (P < 0.001). Fifteen patients (2.9%) were converted to open procedures, and the conversion rate was similar between the 2 groups. The reasons for conversion to open surgery were as follows: bulky tumors in 3 cases, tech nical difficulties with a narrow male pelvis in 4 cases, adhesions to the abdominal and pelvic walls in 3 cases, obesity with high BMI in 2 cases, intraoperative bleeding in 1 case, and tumor perforation during manipulation in 2 cases. There were no significant differences in postoperative length of hospital stay or postoperative surgical and medical morbidities between the two groups. Operative outcomes are shown in Table 2, and details of surgical and medical morbidities are listed in Table 3.
Total thyroidectomy provides radical excision of the gland without leaving any tissue behind so that the risk of recurrent disease is completely eliminated. Unfortunately, subtotal thy- roid ectomy carries a considerable lifelong risk of recurrence for some patients after a long interval; more than mean 25 years in our present series. The surgical treatment of such recurrences is affected by higher morbidity than primary thyroidectomy [12- 15]. The best management of recurrent thyroid pathology is its prevention by primary total thyroidectomy, which is considered the preferred surgical approach as it abolishes the risk of re- cur rence and need for future revision intervention [13,14].
The ZT grade was based on the classification method of Pelizzo et al. , in which 0 = unrecognizable, I ≤5 mm, II = 6~10 mm, III>10 mm. The running pathway of the RLN in the ZT area was classified as either Type A = posterior ZT surface, Type B = anterior ZT surface, Type C = passing throughthe ZT paren- chyma or Type D = lateral of the ZT (Fig. 1). Type D pathways were further classified as D1 = attached to the apex of the ZT, or D2 = departing from the apex of the ZT. In terms of the SP, the location and distance were classified in terms of clock-face image. Cases where the ZT assessment was difficult were excluded form the study, and these included where the ZT con- tained tumors, where there were large tumors involv- ing the entire lobe, chronic thyroiditis.
The patient’s occupational history, work content, environ- ment, social history, past history, and present illness were recorded in detail through history taking and his occupa- tional insurance medical care expenses document, work- relatedness evaluation, medical records, etc. were examined after receiving the consent and cooperation of patient and guardian. Next domestic and foreign publications were reviewed focusing on the epidemiology, pathophysiology and risk factors of laryngealcancer, with emphasis on the relevance to this disease of occupational exposure. After this two occupational and environmental medicine physi- cians visited the workplace of the patient with approval.
We report the case of a 73-year-old man with a history of a Billroth II procedure who presented to the emergency department after 6 hours of epigastric pain and hematemesis. Endoscopy and computed tomography showed in- tussuscepted jejunum through a gastrojejunostomy that required emergency operation. At laparotomy a retrograde type II, JGI was confirmed and managed by resection of involved intestine. Postoperative recovery was uneventful.
laparoscopic or robotic-assisted procedures was almost four times higher than the number of recurrences after open surgery, and this translated into a hazard ratio for disease-free survival (DFS) of 3.74 (at 4.5 years) for MIS versus open surgery. Significantly more patients who underwent MIS died during a median follow-up of 2.5 years (19 patients vs. 3 who underwent open surgery), meaning that women who underwent MIS were 6 times as likely to die during the follow-up period. DFS at 4.5 years after minimally invasive radical hysterectomy was shown to be inferior to that after open surgery. Minimally invasive radical hysterectomy was associated with a higher rate of locoregional recurrence. Results of this trial should be discussed with patients scheduled to undergo radical hysterectomy.
Characteristics of eligible patients are marked in Table 1. The mean age was 31 and 51 years for FSS and for RCS, respec- tively. Endometrioid type was the most frequent. In 10 cases the tumor was poorly differentiated. Ten out of 18 patients in the FSS group were FIGO stage ≥IA grade 3. Data on surgical staging procedures and pathological assessment are shown in Table 1. A median of 22 pelvic and 20 para-aortic nodes were removed. No node metastases were found. Globally, the mean hospital stay was 6 days. We detected a synchronous tumor in the endometrium in a patient in the RCS group.
mentary Fig. 1. A multidisciplinary conference including a sur- geon, gastroenterologist, oncologist, radiologist, radiotherapist, and pathologist was held to decide if the medical downsizing through chemotherapy was adequate to render the disease operable. After being considered resectable, five patients un- derwent extended right hemihepatectomy, four underwent pancreaticoduodenectomy, and the remaining three underwent extended left hemihepatectomy, left trisectionectomy, and ex- tended cholecystectomy, respectively. Four of the 12 patients experienced postoperative complications; three had intra-ab- dominal fluid collections, and one had a wound problem. The median postoperative hospital stay was 13.5 days (range, 8–61 days). Seven patients were treated with adjuvant chemothera- py. Cancer recurred in four patients during follow-up. Patient characteristics are listed in Table 1.
All patients who underwent inguinal hernia surgery in this study were more than 20 years old and the incidence of postprostatectomy hernia among total study cases was 2.4%
(23/963). While there have been various reports with similar results of inguinal hernia surgery for postprostatectomy patients, almost no statistical analysis has been conducted on most studies. The value of this study is to conduct statistical analysis of hernia patients who had undergone prostate cancersurgery with the hernia patients who had not.
Annals of Hepato-Biliary-Pancreatic Surgery ∙ pISSN: 2508-5778ㆍeISSN: 2508-5859
Increased life expectancy is a global trend; over the past two decades, the mean life expectancy has increased from 64 to 71 years of age, and moreover, the mean life expectancy in high-income countries has increased to nearly 80 years. 1 The incidence of cancer increases with age, generating an increased interest in treatments for eld- erly individuals, 2 and therefore, researchers have con- ducted many studies on surgeries for elderly patients with cancer; clinicians have found that most such surgeries are both safe and feasible, with immediate surgical complica- tions, mortality rates, and long-term outcomes comparable with those in younger patients. 3-6
As with most other epithelial cancers, there is a strong relationship between age and gallbladder cancer. 17 In this study, 76.7% of patients in the GBC group were over 60 years old; patients in this group were also significantly older than those in the GBA group. The absence of chol- elithiasis was an independent risk factor for GBC. The as- sociation between GBA and gallstones ranges from 36 to 95%, and gallstones have been also found to be associated with GBC in varying frequency. 18 In this study, the GBA group showed a significantly higher rate of presence of gallstones compared to the GBC group (68.6 vs. 40.0%, p=0.004). If gallstones are absent in patients with an un- clear distinction between GBA and GBC on preoperative imaging, the presence of GBC may be considered.
Most women with advanced ovarian cancer develop recurrent disease after the first- line therapy, and chemotherapy remains the standard care of women with platinum- sensitive recurrent ovarian cancer. The randomized studies (NCT00565851, NCT01166737, NCT01611766) comparing surgery with chemotherapy alone are on the way, and matured data will be reported in recent years [1,2]. The results of these studies may be different because of different clinical practice and different patient population. Different clinical practice came from years of experience and training background of secondary surgical cytoreduction in recurrent ovarian cancer from retrospective or prospective studies.
with isolated local recurrence within 2 years of surgery.
Surgery for breast cancer is gradually developing from radical sur- gery to advanced surgical procedures that allow for oncological safety and improve quality of life. Hence, BCS for breast cancersurgery has become more common, and sentinel lymph node bi- opsy is also slowly becoming the standard for axillary lymph node surgery. Although there have been conflicting reports regarding whether patients who undergo a total mastectomy have a higher quality of life than those who undergo BCS, studies conducting long-term observations have established that patients who under- go BCS tend to have a higher quality of life [16-18]. However, on- cological safety is as important as quality of life. Many prospective randomized studies have verified the oncological safety of BCS.
Comorbidities included diabetes mellitus (DM), hypertension,
obstructive lung disease (OLD), heart problem, chronic kidney disease (CKD), cerebrovascular accident (CVA) history, sepsis at the time of surgery, and previous cancer history. OLD included chronic obstructive pulmonary disease, asthma, and pulmonary emphysema. Heart problem included coronary artery disease, congestive heart failure, atrial fibrillation, aortic stenosis, unstable angina, myocardial infarction, severe heart wall hypokinesia, and sick sinus syndrome. Prostate cancer, thyroid cancer, and skin cancer except for melanoma were not included in the category of previous cancer history. Open or laparoscopic appendectomy was not included in the category of previous laparotomy history, but gynecological surgeries such as cesarean section, uterine myomectomy, and total hysterectomy were included.
performed with low-molecular weight heparin or alprostadil for 2 days through a central intravenous line. The urinary catheter and central intravenous line were removed on POD 1. Fluid replacement was managed in a goal-directed manner while avoiding excessive over- or underhydration. A standard polymeric enteral nutrition formula was administered starting on POD 1, and oral feeding training was started on POD 5 with sips of water while maintaining enteral nutrition. A cold liquid diet was started on POD 7, and enteral nutrition was discontinued when sufficient nutrition was satisfied by oral feeding. Immediately after the operation, analgesics were administered throughthe intravenous line to manage patient pain; paracetamol and available nonsteroidal anti-inflammatory drugs were used in combination. Opioid analgesics were also used at the physician’s discretion. Analgesics were appropriately controlled during the hospitalization period according to the severity of patient’s pain. A single postoperative antibiotic was administered through POD 7. Postoperative mobilization was enacted as soon as possible. Normally, the patient maintained a sitting position until wheelchair ambulation on POD 5, usually after maintaining absolute bedrest through POD 2.
There may be many more opportunities to expand the use of opportunistic salpingectomy. While this procedure is usually done by open or laparoscopic surgery, the majority of patients with normal-sized mobile adnexae can have these successfully removed at the time of vaginal hysterectomy as well, with re- ported rates between 66% and 99% [32-36]. Even if the entire fallopian tube cannot be removed at vaginal hysterectomy, it is the distal portion of the tube in which the vast majority (over 90%) of high-grade serous carcinomas appear to arise [1,3], and this should be accessible after the uterus is removed, or possibly with the assistance of vaginal laparoscopy .
LADG and ODG patients .
However, despite of the favorable results of all of the above studies, there is little evidence of long-term onco- logical outcome of laparoscopic gastrectomy as a treat- ment modality for gastric cancer. Even in a revised 2011 English version of the Japanese gastric cancer treatment guideline 3 rd edition, to be published 15 years after the first case of laparoscopic gastrectomy, laparoscopic gastrec- tomy is still classified as an investigational treatment eligi- ble for EGC . In the early 2000s, phase III evidence be- gan to emerge in Western countries for colon cancer dem- onstrating that the oncologic outcomes of laparoscopic co- lon operation are similar to those of open colon operation and the new procedure is associated with less pain and shorter hospital stay. Undoubtedly, most surgeons have now accepted laparoscopic surgery for colon cancer. In contrast, the long-term results of multi-center randomized controlled trials of laparoscopic versus open gastrectomy are needed to establish the future role of laparoscopic sur- gery in the treatment of patients with gastric cancer. The KLASS trial completed the enrollment of patients in 2010.
However, electrical muscle activities larger than the 100–150 μV thresholds could easily be elicited by direct EBSLN stimulation in 73.7% of the cases.
Although the present study was a pilot study for the feasi- bility of EBSLN monitoring during BABA robotic thyroid surgery, we discovered that EBSLN monitoring is useful to preserve voice quality. We observed a minimal voice change in patients using EBSLN monitoring during BABA robotic thyroid surgery; however, this change normalized at 3 months postoperatively compared to preoperatively. We now need further prospective ran domized studies to evaluate the advantages of EBSLN monitoring over
investigation from our study group including more than 300 patients affected by early stage ovarian cancer, suggested the safety of conservative approach in early stage ovarian cancer.
Moreover, a sub-analysis of our data suggested that the ex- ecution of FSS rather than RCS does not influence outcomes of high-risk ovarian cancer . Using a propensity-matched comparison (in order to minimize possible selection bias) we observed that high-risk ovarian cancers are characterized by similar disease-free and overall survivals than patients under- going RCS . Similarly, data of 221 patients, undergoing FSS in 30 institutions (belonging to the Gynecologic Cancer Study Group of the Japan Clinical Oncology Group), suggested that stage IC ovarian cancer or patients with unfavorable histology (e.g., clear cell) may benefit from conservative approach .