To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatme...To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatment of difficult liver colorectal metastases （CRM） and right-lung CRM, reporting their experience in a cohort of 11 patients.展开更多
The Author Reply：We thank Dr. Sucameli et al. for the interest toward our article[1] and for the opportunity for further discussing on this issue,providing a case report of single metastastic fore sites in the livera...The Author Reply：We thank Dr. Sucameli et al. for the interest toward our article[1] and for the opportunity for further discussing on this issue,providing a case report of single metastastic fore sites in the liverand lung both treated in a minimal access fashion. However, giventhe interest of the authors insight, it appears misleading when related to that discussed in our report which was clearly referred toother patients＇ profiles. Indeed, they described a case with a singleperipheral nodule in the right lung and a single liver metastasesin segment 5. This uncommon situation （less than 2% of patientsaccording to the LiverMetSurvey registry [2]）, is obviouslya more than reasonable indication for a mini-invasive approach.However, our patients received surgery for complex oncological involvementof the liver： as described, this means large and/or multiplelesions, in contact or invading the hepatic veins at caval confluence.For such conditions we have introduced original surgicalapproaches [3,4]： in such conditions we would select a J-shapedthoracophrenolaparotomy for the liver per se [5]. This incision forsuch complex conditions other than allowing the liver clearance in a single operation rather than in staged approach [6], allows justin case the removal of lung nodules. Therefore, we thank again theauthors for their interest to our report, and furthermore we congratulatefor the original management of the shared clinical case.However, the condition recalled by the authors is related to a scenariooncologically and surgically at the opposite side of that discussedin our paper and for that somehow suggesting a comparisonis misleading.展开更多
AIM: To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.METHODS: Forty-eight small duct CP ...AIM: To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.METHODS: Forty-eight small duct CP patients were treated invasively with NCPB (n = 30) or VSPL (n = 18) in two non-randomized, prospective, case-controlled protocols due to chronic pain syndrome, and compared to a control group who were treated conservatively (n = 32). Visual analog scales were used to assess pain and opioid consumption rate was evaluated. In addition, the quality of life was measured using QLQ C-30 for NCPB and FACIT for VSPL.Although both questionnaires covered similar problems,they could not be compared directly one with another.Therefore, the studies were compared by meta-analysis methodology.RESULTS: Both procedures resulted in a significant positive effect on pain of CP patients. Opioids were withdrawn totally in 47.0% of NCPB and 36.4% of VSPL patients,and reduced in 53.0% and 45.4% of the respective patient groups. No reduction in opioid usage was observed in the control group. In addition, fatigue and emotional well-being showed improvements. Finally, NCPB demonstrated stronger positive effects on social support, which might possibly be attributed to earlier presentation of patients treated with NCPB.CONCLUSION: Both invasive pain treatment methods are effective in CP patients with chronic pain.展开更多
文摘To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatment of difficult liver colorectal metastases （CRM） and right-lung CRM, reporting their experience in a cohort of 11 patients.
文摘The Author Reply：We thank Dr. Sucameli et al. for the interest toward our article[1] and for the opportunity for further discussing on this issue,providing a case report of single metastastic fore sites in the liverand lung both treated in a minimal access fashion. However, giventhe interest of the authors insight, it appears misleading when related to that discussed in our report which was clearly referred toother patients＇ profiles. Indeed, they described a case with a singleperipheral nodule in the right lung and a single liver metastasesin segment 5. This uncommon situation （less than 2% of patientsaccording to the LiverMetSurvey registry [2]）, is obviouslya more than reasonable indication for a mini-invasive approach.However, our patients received surgery for complex oncological involvementof the liver： as described, this means large and/or multiplelesions, in contact or invading the hepatic veins at caval confluence.For such conditions we have introduced original surgicalapproaches [3,4]： in such conditions we would select a J-shapedthoracophrenolaparotomy for the liver per se [5]. This incision forsuch complex conditions other than allowing the liver clearance in a single operation rather than in staged approach [6], allows justin case the removal of lung nodules. Therefore, we thank again theauthors for their interest to our report, and furthermore we congratulatefor the original management of the shared clinical case.However, the condition recalled by the authors is related to a scenariooncologically and surgically at the opposite side of that discussedin our paper and for that somehow suggesting a comparisonis misleading.
文摘AIM: To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.METHODS: Forty-eight small duct CP patients were treated invasively with NCPB (n = 30) or VSPL (n = 18) in two non-randomized, prospective, case-controlled protocols due to chronic pain syndrome, and compared to a control group who were treated conservatively (n = 32). Visual analog scales were used to assess pain and opioid consumption rate was evaluated. In addition, the quality of life was measured using QLQ C-30 for NCPB and FACIT for VSPL.Although both questionnaires covered similar problems,they could not be compared directly one with another.Therefore, the studies were compared by meta-analysis methodology.RESULTS: Both procedures resulted in a significant positive effect on pain of CP patients. Opioids were withdrawn totally in 47.0% of NCPB and 36.4% of VSPL patients,and reduced in 53.0% and 45.4% of the respective patient groups. No reduction in opioid usage was observed in the control group. In addition, fatigue and emotional well-being showed improvements. Finally, NCPB demonstrated stronger positive effects on social support, which might possibly be attributed to earlier presentation of patients treated with NCPB.CONCLUSION: Both invasive pain treatment methods are effective in CP patients with chronic pain.
