scholarly journals Laparoscopic Nephroureterectomy and Management of the Distal Ureter: A Review of Current Techniques and Outcomes

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Davis P. Viprakasit ◽  
Amanda M. Macejko ◽  
Robert B. Nadler
Keyword(s):  
Transitional Cell ◽  
Cancer Control ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Oncologic Outcomes ◽  
En Bloc ◽  
Distal Ureter ◽  
Perioperative Morbidity ◽  
Laparoscopic Nephroureterectomy

Laparoscopic nephroureterectomy (LNU) is becoming an increasingly common alternative treatment for transitional cell carcinoma (TCC) of the renal pelvis and ureter due to decreased perioperative morbidity, shorter hospitalization, and comparable oncologic control with open nephroureterectomy (ONU). Mobilization of the kidney and proximal ureter may be performed through a transperitoneal, retroperitoneal, or hand-assisted approach. Each technique is associated with its own benefits and limitations, and the optimal approach is often dictated by surgeon preference. Our analysis of the literature reflects equivalent cancer control between LPN and OPN at intermediate follow-up with significantly improved perioperative morbidity following LPN. Several methods for bladder cuff excision have been advocated, however, no individual technique for management of the distal ureter proved superior. Overall, complete en-bloc resection with minimal disruption of the urinary tract should be optimized to maintain oncologic outcomes. Longer follow-up and prospective studies are needed to fully evaluate these techniques.

scholarly journals Laparoscopic Transvesical Resection of an En Bloc Bladder Cuff and Distal Ureter during Nephroureterectomy

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Stilianos Giannakopoulos ◽  
George Toufas ◽  
Charalampos Dimitriadis ◽  
Stavros Giannopoulos ◽  
Christos Kalaitzis ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Bladder Tumor ◽  
Transitional Cell ◽  
Operating Time ◽  
En Bloc ◽  
Distal Ureter ◽  
Safe Technique ◽  
Transvesical Approach ◽  
Laparoscopic Nephroureterectomy

Objective. The most appropriate technique for excising the distal ureter and bladder cuff during laparoscopic nephroureterectomy is still debated. We report our experience with a pure laparoscopic transvesical method that duplicates the long-standing open transvesical approach.Materials and Methods. Seven men and three women diagnosed with upper tract transitional cell carcinoma were treated with this procedure. Three intravesical ports were inserted, and pneumovesicum was established at 12 mmHg. Transvesical laparoscopic circumferential detachment of the bladder cuff and en bloc mobilization of the last centimeters of the distal ureter were performed, followed by the closure of the bladder defect. Subsequently, a nephrectomy was performed either laparoscopically or using an open flank approach.Results. The median age was 68.5 years. The procedure was completed uneventfully in all cases. The median operating time for distal ureter excision was 82.5 minutes (range 55–120). No complications directly related to the pneumovesicum method were recorded. The median follow-up period was 31 months (range 12–55). During the follow-up period, two patients (20%) died from the disease, and a bladder tumor developed in three cases (30%).Conclusion. The laparoscopic transvesical resection of the en bloc bladder cuff and distal ureter is a reliable, effective, and oncologically safe technique, at least in the midterm.

Metastasectomy for melanoma in the VATS era

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20001-e20001
Author(s):  
A. Bhargava ◽  
M. J. Schuchert ◽  
D. O. Wilson ◽  
R. J. Landreneau ◽  
J. D. Luketich ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Wedge Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Open Group ◽  
Oncologic Outcomes ◽  
Open Approach ◽  
En Bloc ◽  
Curative Intent ◽  
Perioperative Morbidity

e20001 Background: The role for metastasectomy in the setting of metastatic melanoma remains ill-defined. The aim of this study is to evaluate resection of limited metastases in the setting of melanoma comparing VATS and open approaches, specifically looking at perioperative morbidity and survival. Methods: All patients undergoing metastasectomy for melanoma with curative intent between January 1, 2001 and September 30, 2007 were included. Data was collected retrospectively from the UPMC tumor registry and chart review. Differences between groups were compared with the student's t-test. Results: Of 43 patients undergoing metastasectomy for melanoma, 31 patients were resected with intent to cure (16 VATS, 15 open). Complications were similar between the VATS (12%) and open (13%) groups. There were no perioperative deaths in either group. The median survival in the VATS group was 20.7 months, compared to 26.5 months in the open group (p = 0.17). Importantly, the VATS patients more frequently underwent resection of smaller, peripheral lesions via wedge resection (81%) and only 2 patients (13%) underwent lobectomy. Conversely, patients undergoing open procedures were more likely to have larger, more central lesions and undergo anatomic resections. There were 9 (60%) lobectomies, 3 (20%) segmentectomies 1 (7%) en bloc resection and only 2 (13%) wedge resections in the open group. Conclusions: Metastasectomy for metastatic melanoma in the thoracic cavity can be performed safely by a VATS or open approach. The two approaches have comparable morbidity, mortality and survival outcomes. Careful patient resection remains the hallmark of care in identifying appropriate candidates for metastasectomy. In the setting of patients with short life-expectancy, it may be advantageous to employ a VATS approach when possible to preserve quality of life while achieving similar oncologic outcomes to open procedures. Individuals with a radiographic indication of limited peripheral disease should be considered for a VATS approach to resection of melanoma metastases. No significant financial relationships to disclose.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

scholarly journals Parathyroid carcinoma

2006 ◽  
Vol 63 (8) ◽  
pp. 765-769
Author(s):  
Aleksandar Filipovic ◽  
Ivan Paunovic ◽  
Dragutin Savjak ◽  
Tamara Zivkovic
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Disease Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Endocrine Tumors ◽  
En Bloc ◽  
Histologic Diagnosis ◽  
Serum Pth

Background. Parathyroid carcinoma is the least frequent malignancy among endocrine tumors. In the most reported series of patients with primary hyperparathyroidism the incidence of carcinoma is less than 1%. Recognition by a surgeon that the parathyroid tumor is malignant, and the performance of an adequate en bloc removal of primary lesion, with histologic diagnosis offer the best treatment of a patient with this unusual malignancy. Case report. We reported a 30-year-old patient with parathyroid carcinoma, primary hyperparathyroidism, and recurrent nephrocalcinosis. Marked hypercalcemia, low serum phosphorus, and substantial elevation of serum parathyroid hormone indicated a diagnosis of primary hiperparathyroidism. General symptoms were anorexia, muscle weakness, back pain and depression. Ultrasonography done before the surgery revealed a 2 cm upper left parathyroid gland with solid and cystic areas. The neck exploration was done with en block resection of the tumor. A histopathological evaluation confirmed the diagnosis of parathyroid carcinoma. Over more than a three-year-follow-up, the patient had no evidence of the disease recurrence and his serum PTH and calcium levels remained within the normal. Conclusion. Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. Preoperative diagnosis remains a challenge. Radical en bloc resection of the tumor is the treatment of choice for this malignancy.

En Bloc Resection of the Duodenum for Locally Advanced Right Colon Adenocarcinoma

2007 ◽  
Vol 73 (10) ◽  
pp. 1063-1066 ◽  
Author(s):  
Ahmad N. Hakimi ◽  
David K. Rosing ◽  
Bruce E. Stabile ◽  
Beverley A. Petrie
Keyword(s):  
Colon Cancer ◽  
Locally Advanced ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Morbidity And Mortality ◽  
Right Colon ◽  
En Bloc ◽  
Adjacent Structures ◽  
Duodenal Invasion

Direct invasion of colorectal adenocarcinoma into adjacent structures occurs frequently, but only rarely is the duodenum involved. This study was undertaken to assess the safety and efficacy of en bloc resection of locally advanced right colon carcinoma invading the duodenum. A retrospective review of 49 patients with locally advanced colon cancer, surgically managed between 2000 and 2005, was performed. Forty-six patients underwent en bloc resection of colon and adjacent organs not involving the duodenum. Three patients with duodenal invasion underwent en bloc partial duodenectomy. The mean operative blood loss, length of stay, postoperative morbidity, and mortality compare favorably between these two groups of patients. Of the 46 patients with en bloc resection of other organs, 27 are alive at 12 to 60 months follow up. Two patients with duodenal invasion are alive without recurrence at 15 and 20 months follow up. En bloc resection of colon cancer invading the duodenum can be performed safely because morbidity and mortality rates are comparable to those attending extended resections of other locally advanced colon carcinomas. Overall survival in patients who underwent surgery with curative intent justifies en bloc duodenal resection in selected patients.

scholarly journals Mandibular periosteal (juxtacortical) chondrosarcoma

2009 ◽  
Vol 20 (5) ◽  
pp. 428-433 ◽  
Author(s):  
Elisângela Maria Cunha Costa ◽  
Bárbara Lima Lucas ◽  
Mariana Reis Silva ◽  
Renata Hinhug Vilarinho ◽  
Paulo Rogério de Faria ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Surface ◽  
En Bloc ◽  
Grade Ii ◽  
Well Differentiated ◽  
Slow Growing ◽  
Tomography Scan

Periosteal (juxtacortical) chondrosarcoma (PC) is a well-differentiated malignant cartilage-forming tumor arising from the external bone surface, especially in long bones. The therapy of choice is en-bloc resection and, in general, its prognosis is good. This paper reports a rare case of PC affecting the mandible of a 41-year-old man. The lesion presented as a slow-growing-painless swelling that lasted 2 months. Computed tomography scan showed a tumoral mass arising from the external bone surface, extending into the adjacent soft tissue presenting patchy regions of popcorn-like calcifications. A final diagnosis of PC (grade II) was rendered after biopsy. Hemimandibulectomy was undertaken followed by complementary radiotherapy with 70 Gy. Although no episodes of recurrence or metastasis had been noticed after 18 months of follow-up, the patient died and causa mortis could not be established.

Therapeutic strategy involving endoscopic resection for cN0 superficial carcinoma of the esophagus.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 1-1
Author(s):  
T. Iizuka ◽  
D. Kikuchi ◽  
S. Hoteya
Keyword(s):  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Additional Treatment ◽  
En Bloc ◽  
Carcinoma Of The Esophagus ◽  
Secondary Hemorrhage ◽  
Long Term Follow Up

1 Background: With the progress in endoscopic submucosal dissection (ESD) which enables en bloc resection irrespective of the size of lesion, a therapeutic strategy has become feasible whereby ESD is undertaken first, followed by considering additional treatment based on the results of histologic exploration. In this study, we attempted to clarify the clinical results in patients who had undergone additional treatment after endoscopic resection (ER) for cN0 superficial carcinoma. Methods: Of 140 patients diagnosed as having T1a-MM-SM2 lesions of squamous cell carcinoma of the esophagus who had undergone ER between January 1998 and March 2010, 83 patients who received additional treatment after ER (surgery, 27 pts; chemoradiotherapy [CRT], 56 pts.) were the subjects of this study. The mean duration of observation was 45.1 months. Results: The en bloc resection rate was 86%. There were 5 patients (6%) who had complications associated with ER, including perforation in 2 patients, secondary hemorrhage in a patient and pneumonia in 2 patients. Complications associated with additional treatment were noted in 13 patients (15.6%), including secondary hemorrhage, recurrent laryngeal nerve paralysis and pulmonary infarction in one patient each, pneumonia in 3, grade ≥ 3 myelosuppression in 5, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and radiation pneumonitis in one patient each. Long-term follow-up revealed no local recurrence and no patients who experienced late toxicity due to CRT. The tumor recurred in 4 patients, the site of recurrent lesion being the mediastinum in 3 patients and the cervical lymph node in one patient, of whom 2 patients died of the primary disease. The 5-year survival rate was 88.4%. Conclusions: Endoscopic resection plus additional treatment for superficial carcinoma of the esophagus did not entail the development of any serious complications; thus, such combined treatment was safe and feasible. The long-term follow-up results were fairly gratifying, and ER with subsequent additional treatment is considered to be valid for patients with cN0 superficial carcinoma of the esophagus. No significant financial relationships to disclose.

En Bloc Resection of Lamina and Ossified Ligamentum Flavum in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1181-1186 ◽  
Author(s):  
Lian-shun Jia ◽  
Xiong-sheng Chen ◽  
Sheng-yuan Zhou ◽  
Jiang Shao ◽  
Wei Zhu
Keyword(s):  
Evaluation System ◽  
Ligamentum Flavum ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Neurological Dysfunction ◽  
Thoracic Myelopathy ◽  
En Bloc ◽  
Improvement Rate ◽  
The Mean

Abstract OBJECTIVE We performed a retrospective patient chart review to determine the feasibility and safety of en bloc resection of lamina and ossified ligamentum flavum in the treatment of thoracic ossification of ligamentum flavum (OLF). METHODS From January 2000 to June 2006, 36 patients with thoracic OLF underwent en bloc resection of lamina and ossified ligamentum flavum by a burr-grinding technique. The range of resection included one lamina superior and one lamina inferior to the diseased segments. Ossified dura mater was removed if present, and simultaneous repair was carried out. RESULTS The mean preoperative Japanese Orthopedic Association (JOA) score (an evaluation system for thoracic myelopathy with a total score of 11 points) was 5 points (range, 3–9 points). The mean JOA score at the last follow-up visit (mean follow-up period, 3.9 years) was 8.44 points (range, 6–11 points). The range of improvement was from 2 to 6 points, and the mean improvement rate was 60.5% (range, 33.3%–100%). No postoperative aggravation of neurological dysfunction, leakage of cerebrospinal fluid (CSF), wound infection, kyphosis, or recurrence occurred. A CSF cyst found in one patient 3 weeks postoperatively was absorbed automatically after 10 months. CONCLUSION The en bloc resection technique described here is both safe and effective.

scholarly journals Tumor rupture of gastric gastrointestinal stromal tumors during endoscopic resection: a risk factor for peritoneal metastasis?

2018 ◽  
Vol 06 (08) ◽  
pp. E950-E956 ◽  
Author(s):  
Shiyi Song ◽  
Wei Ren ◽  
Yi Wang ◽  
Shu Zhang ◽  
Song Zhang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Endoscopic Resection ◽  
Peritoneal Metastasis ◽  
Gastrointestinal Stromal Tumors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Rupture ◽  
En Bloc ◽  
Stromal Tumors

Abstract Background and study aims Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. Up to the present time, complete surgical excision has been the standard treatment for primary GISTs greater than 2 cm. It is well known that tumor rupture during surgery is an independent risk factor for peritoneal metastasis; however, it is not known whether the risk of peritoneal metastasis increases in cases where the tumor is ruptured during endoscopic resection. Patients and methods A total of 195 patients treated for GIST between January 2014 and December 2016 in our hospital were enrolled in this study. They were divided into two groups according to whether the tumor was ruptured during endoscopic resection. The rate of peritoneal metastasis in patients in the two groups who also suffered perforation was investigated from the follow-up results. Results Approximately 55.4 % of all patients were female and the average age of the study group was 59.0 ± 10.3 years. Of the 195 patients, the tumors in 27 were ruptured and the remaining 168 patients underwent en bloc resection. There was no statistically significant difference in gender or age between the two groups. The median tumor size (maximum diameter) in all patients was 1.5 cm (0.3 – 5.0 cm): 2.5 cm (0.8 – 5.0 cm) and 1.4 cm (0.3 – 4.0 cm) in the tumor rupture group and en bloc resection group, respectively (P < 0.001). Most of the tumors were located in the gastric fundus. At a median follow-up of 18.7 ± 10.2 months, neither tumor recurrence (liver metastasis, peritoneal metastasis, local recurrence) nor mortality related to GISTs were detected. Conclusions Tumor rupture during endoscopic resection of gastric GISTs may not be a risk factor for peritoneal metastasis.

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