SURGICAL MANAGEMENT OF CARCINOMA OF THE HEAD OF PANCREAS: EXTENDED LYMPHADENECTOMY OR MODIFIED EN BLOC RESECTION?

Abstract Background A 54-year-old female was referred to our clinic with a lesion of the lower fourth ventricle extending to the median aperture. Here, we report the use a minimally invasive sub-occipital approach (MISA) as a safe and effective surgical management. Method We performed a MISA using a short midline incision and a 1-cm sub-occipital craniectomy. Dissection of the lesion was performed, and “en bloc” resection could be achieved. The lesion was confirmed to be a grade I sub-ependymoma. Conclusion MISA can be safely used when confronted to a lesion of the lower fourth ventricle.

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Combined en-bloc resection of celiac and superior mesenteric arteries in surgical management of locally advanced pancreatic cancer

HPB ◽

10.1016/j.hpb.2021.06.212 ◽

2021 ◽

Vol 23 ◽

pp. S563

Author(s):

Y. Genyk ◽

J. Lipinska ◽

R. Sheikh

Keyword(s):

Pancreatic Cancer ◽

Surgical Management ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

En Bloc Resection ◽

Bloc Resection ◽

Mesenteric Arteries ◽

Locally Advanced Pancreatic Cancer ◽

En Bloc

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Surgical management of rare benign tumors of the sternum

MOJ Clinical & Medical Case Reports ◽

10.15406/mojcr.2021.11.00389 ◽

2021 ◽

Vol 11 (3) ◽

pp. 88-94

Author(s):

Andrei I Gritsiuta

Keyword(s):

Giant Cell ◽

Surgical Management ◽

Surgical Techniques ◽

En Bloc Resection ◽

Bloc Resection ◽

Benign Tumors ◽

Giant Cell Tumors ◽

En Bloc ◽

Synthetic Materials ◽

Long Term Follow Up

Primary benign tumors of the sternum are an exceedingly rare entity. Surgical techniques regarding intervention for these lesions are not clearly defined in the literature given their scarcity. Operative techniques include en-bloc resection of the tumor, and this has proven to be successful in preventing local recurrence despite benign nature of the lesion. Given the often extensive defect created by the excision, reconstruction is frequently necessary; depending on the size of the defect, either autologous bone grafting or the use of synthetic materials may be indicated. This study serves to present two cases of rare primary benign tumors of the sternum, giant cell tumors and osteoma spongiosum and to summarize the available literature. We present a review of the literature of 17sternal giant cell tumor cases reported so far including our patient and unique case of osteoma spongiosum of the sternum, that discusses their surgical management, as well as reconstructive techniques that provided an excellent clinical result and a lack of recurrence on long term follow-up.

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Mediastinal herniation of the biliary tract leading to bile duct obstruction following oesophagectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0134 ◽

2018 ◽

Vol 100 (8) ◽

pp. e211-e213

Author(s):

A Laliotis ◽

T Hettiarachchi ◽

F Rashid ◽

A Hindmarsh ◽

V Sujendran

Keyword(s):

Bile Duct ◽

Surgical Management ◽

Standard Treatment ◽

Locally Advanced ◽

Significant Risk ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Abdominal Organs ◽

Increased Risk

Surgical management of oesophageal and gastro-oesophageal junction malignancies is one of the most challenging situations confronting the surgeon. Attaining a complete circumferential resection margin of lower-third oesophageal and gastro-oesophageal junction locally advanced carcinomas requires en-bloc resection of the hiatus and all the peri-oesophageal tissue and pleura. This results in an increased risk of herniation of the abdominal organs through the enlarged hiatus, which carries significant risk of morbidity and mortality. The incidence of this complication is higher than has been reported. Surgical management of symptomatic hernias is the standard treatment while criteria for managing asymptomatic hernias are less clear. We report a rare case of a late mediastinal herniation of the pancreas and bile duct, leading to obstructive jaundice following oesophagectomy which was treated successfully in our unit.

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Patterns of recurrence after neoadjuvant docetaxel, cisplatin, and 5FU combined with resection and extended lymphadenectomy for locally advanced esophagogastric adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15044 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15044-e15044

Author(s):

Lorenzo Ferri ◽

Thierry Alcindor ◽

Steven Ades ◽

Abdullah Aloraini ◽

Marie Vanhuyse ◽

...

Keyword(s):

Lymph Nodes ◽

Locally Advanced ◽

En Bloc Resection ◽

Bloc Resection ◽

Regional Recurrence ◽

Extended Lymphadenectomy ◽

En Bloc ◽

Regional Lymph Nodes ◽

Low Rate

e15044 Background: We have previously identified Docetaxel, Cisplatin, and 5FU (DCF) as a highly effective regimen in the neoadjuvant setting for locally advanced adenocarcinoma (ADC) of the esophagus and esophago-gastric junction (EGJ). However there is ongoing debate whether chemotherapy alone provides adequate local or regional control. We hypothesized that DCF combined with enhanced local surgical control would result in a low rate of local or regional recurrence. Methods: A prospective entered database of all esophageal/EGJ ADC pts resected at a high volume referral center was reviewed for cases treated with neoadjuvant DCF (Docetaxel 75mg/m2, Cisplatin 75mg/m2, 5FU 750mg/m2x120 hrs CIV) Q3weeks x3, followed by en-bloc resection with extended lymphadenectomy (D2). Follow up included physical exam Q3m x 2 yrs then Q6m, and endoscopy and CT chest/abdo/pelvis performed Q6 m. Recurrence was defined as: Local = biopsy on endoscopy; Regional = regional lymph nodes; Distant = distant organ or non-regional lymph nodes. Data presented as Median (Range). Results: Of 281 pts in the database, 89 (75%male, 63yrs(24-80)) underwent pre-op DCF and resection for locally advanced ADC (cT3 93%;cN+ 73%) of the EGJ (51%) or distal esophagus (49%) from 3/07-10/12. After overall follow-up of 37(6-72) months, 37 (42%) have recurred at 15(6-33) months. Sites of recurrence include Distant only in 29/37, Regional only in 5/37, and Regional and Distant in 3/37. First site of distant recurrence was peritoneum (14/37), liver (10/37), non-regional lymph nodes (10), brain/ovary/pleura (2 each), and bone(1). No patient had local recurrence alone. 3/5 patients with regional recurrence underwent salvage chemoradiotherapy and are alive without disease at 36 months (30-47) after recurrence. Conclusions: En-bloc resection with extended lymphadenectomy after DCF for locally advanced ADC of the esophagus and EGJ is associated with a low rate of local and regional recurrence. As vast majority of recurrences are distant, our data supports the notion that efforts to improve outcomes in these pts should concentrate on enhancing systemic, rather than local, therapy.

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Surgical Treatment for Right Colon Cancer Directly Invading the Duodenum

The American Surgeon ◽

10.1177/000313480907500507 ◽

2009 ◽

Vol 75 (5) ◽

pp. 385-388

Author(s):

Yuan Lianwen ◽

Zhou Jianping ◽

Shu Guoshun ◽

Liu Dongcai ◽

Zhou Jiapeng

Keyword(s):

Colon Carcinoma ◽

Surgical Management ◽

Management Strategies ◽

Perioperative Period ◽

En Bloc Resection ◽

Bloc Resection ◽

Right Colon ◽

En Bloc ◽

Right Colon Cancer ◽

Duodenal Invasion

Right colon carcinoma with duodenal invasion is rare, and optimal management remains controversial. Twenty patients demonstrating right-colon carcinoma directly invading the duodenum presented at the Second Xiangya Hospital between 1990 and 2006. Different surgical management strategies were selected based on duodenal involvement, and patient outcomes were evaluated. There was no perioperative death in this series, but three major complications presented during the perioperative period: one case of duodenal stenosis and two duodenal leaks due to gastric or duodenal drainage. Eight of 13 patients treated by en bloc resection survived more than 3 years, including one 10-year survivor and four 5-year survivors. Of the seven patients treated with palliative resection, no patients survived more than 18 months. In conclusion, duodenal invasion by a right-sided colon carcinoma does not necessarily represent incurable disease. If carefully applied based on the extent of duodenal invasion, active surgical management is very useful for improving patient prognosis without increasing the risks associated with surgery.

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