AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008,...AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in f ive patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, preand intra-operative defi nite localization and careful operative techniques are required.展开更多
BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical method.AIM To summarize the t...BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical method.AIM To summarize the technique and feasibility of robotic resection of DGISTs.METHODS The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1,2010 and May 1,2020 were retrospectively analyzed.The patients were divided into the open surgery group and the robotic surgery group.Pancreatoduodenectomy(PD)or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla.Age,sex,tumour location,tumour size,operation time(OT),estimated blood loss(EBL),postoperative hospital stay(PHS),tumour mitosis,postoperative risk classification,postoperative recurrence and recurrence-free survival were compared between the two groups.RESULTS Of the 28 patients included,19 were male and 9 were female aged 51.3±13.1 years.Limited resection was performed in 17 patients,and PD was performed in 11 patients.Eleven patients underwent open surgery,and 17 patients underwent robotic surgery.Two patients in the robotic surgery group underwent conversion to open surgery.All the tumours were R0 resected,and there was no significant difference in age,sex,tumour size,operation mode,PHS,tumour mitosis,incidence of postoperative complications,risk classification,postoperative targeted drug therapy or postoperative recurrence between the two groups(P>0.05).OT and EBL in the robotic group were significantly different to those in the open surgery group(P<0.05).All the patients survived during the follow-up period,and 4 patients had recurrence and metastasis.No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group(P>0.05).CONCLUSION Robotic resection is safe and feasible for patients with DGISTs,and its therapeutic effect is equivalent to open surgery.展开更多
Duodenal gastrointestinal stromal tumors(D-GISTs)are uncommon mesenchymal tumors and are managed differently to common duodenal epithelial tumors.They may pose surgical challenges due to their unique but complex pancr...Duodenal gastrointestinal stromal tumors(D-GISTs)are uncommon mesenchymal tumors and are managed differently to common duodenal epithelial tumors.They may pose surgical challenges due to their unique but complex pancreaticoduodenal location of the gastrointestinal tract near the ampulla of Vater,pancreas,mesenteric blood vessels,biliary and pancreatic ducts.The surgical management of D-GISTs can be performed safely with good oncological outcomes provided an adequate resection margin can be achieved.The current surgical options of resectable primary D-GISTs varies with increasing complexity depending on the location,size and involvement of surrounding structures such as wedge resection with primary closure,segmental resection with small bowel anastomosis or radical pancreaticoduodenectomy.Laparoscopic approaches have been shown to be feasible and safe with good oncological outcomes in experienced hands.The minimally invasive techniques including robotic-assisted approach will likely increase in the future.D-GISTs have a prognosis comparable to gastric and other small bowel GISTs.However,the heterogeneity of different studies and the limited use of systemic tyrosine kinase inhibitor in the neoadjuvant and adjuvant settings may influence the overall survival of resected D-GISTs.The use of limited resection when condition allows is recommended due to lower surgical morbidity,less postoperative complications and better oncologic outcomes.展开更多
Background.The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection(LSARR)depending upon the extent and severi...Background.The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection(LSARR)depending upon the extent and severity of the disease.Objective.To report the efficacy of LSARR in terms of pain,quality of life and short-and long-term complications—in particular,those pertaining to bowel function.Methods.The case notes of all patients undergoing LSARR were reviewed.The analysed variables included surgical complications,overall symptomatic improvement rate,dysmenorrhoea,dyspareunia,and dyschezia.Chronic pain was measured using a visual analogue scale.Quality of life was measured using the EQ-5D questionnaire.Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre(MSKCC)questionnaire.Results.Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study.Sixty-nine(93.2%)women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem.Approximately 42%of women who wished to conceive had at least one baby.The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score.Post-operative complications were recorded in 14.9%of cases.Conclusions.LSARR for rectal endometriosis is associated with a high degree of symptomatic relief.Pain relief achieved following LSARR does not appear to degrade with time.As anticipated,some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction.展开更多
基金Supported by IN-SUNG Foundation for Medical Research # CA98111
文摘AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in f ive patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, preand intra-operative defi nite localization and careful operative techniques are required.
文摘BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical method.AIM To summarize the technique and feasibility of robotic resection of DGISTs.METHODS The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1,2010 and May 1,2020 were retrospectively analyzed.The patients were divided into the open surgery group and the robotic surgery group.Pancreatoduodenectomy(PD)or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla.Age,sex,tumour location,tumour size,operation time(OT),estimated blood loss(EBL),postoperative hospital stay(PHS),tumour mitosis,postoperative risk classification,postoperative recurrence and recurrence-free survival were compared between the two groups.RESULTS Of the 28 patients included,19 were male and 9 were female aged 51.3±13.1 years.Limited resection was performed in 17 patients,and PD was performed in 11 patients.Eleven patients underwent open surgery,and 17 patients underwent robotic surgery.Two patients in the robotic surgery group underwent conversion to open surgery.All the tumours were R0 resected,and there was no significant difference in age,sex,tumour size,operation mode,PHS,tumour mitosis,incidence of postoperative complications,risk classification,postoperative targeted drug therapy or postoperative recurrence between the two groups(P>0.05).OT and EBL in the robotic group were significantly different to those in the open surgery group(P<0.05).All the patients survived during the follow-up period,and 4 patients had recurrence and metastasis.No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group(P>0.05).CONCLUSION Robotic resection is safe and feasible for patients with DGISTs,and its therapeutic effect is equivalent to open surgery.
文摘Duodenal gastrointestinal stromal tumors(D-GISTs)are uncommon mesenchymal tumors and are managed differently to common duodenal epithelial tumors.They may pose surgical challenges due to their unique but complex pancreaticoduodenal location of the gastrointestinal tract near the ampulla of Vater,pancreas,mesenteric blood vessels,biliary and pancreatic ducts.The surgical management of D-GISTs can be performed safely with good oncological outcomes provided an adequate resection margin can be achieved.The current surgical options of resectable primary D-GISTs varies with increasing complexity depending on the location,size and involvement of surrounding structures such as wedge resection with primary closure,segmental resection with small bowel anastomosis or radical pancreaticoduodenectomy.Laparoscopic approaches have been shown to be feasible and safe with good oncological outcomes in experienced hands.The minimally invasive techniques including robotic-assisted approach will likely increase in the future.D-GISTs have a prognosis comparable to gastric and other small bowel GISTs.However,the heterogeneity of different studies and the limited use of systemic tyrosine kinase inhibitor in the neoadjuvant and adjuvant settings may influence the overall survival of resected D-GISTs.The use of limited resection when condition allows is recommended due to lower surgical morbidity,less postoperative complications and better oncologic outcomes.
文摘Background.The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection(LSARR)depending upon the extent and severity of the disease.Objective.To report the efficacy of LSARR in terms of pain,quality of life and short-and long-term complications—in particular,those pertaining to bowel function.Methods.The case notes of all patients undergoing LSARR were reviewed.The analysed variables included surgical complications,overall symptomatic improvement rate,dysmenorrhoea,dyspareunia,and dyschezia.Chronic pain was measured using a visual analogue scale.Quality of life was measured using the EQ-5D questionnaire.Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre(MSKCC)questionnaire.Results.Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study.Sixty-nine(93.2%)women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem.Approximately 42%of women who wished to conceive had at least one baby.The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score.Post-operative complications were recorded in 14.9%of cases.Conclusions.LSARR for rectal endometriosis is associated with a high degree of symptomatic relief.Pain relief achieved following LSARR does not appear to degrade with time.As anticipated,some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction.
