Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach – an analysis of the ACS-NSQIP database

Introduction Fewer than 10% of colon cancers are found at the splenic flexure. A standard surgical approach to these cancers has not been defined. The goal of this study was to compare lymph node harvest and post-operative morbidity between segmental resection and formal left hemicolectomy for splenic flexure colon cancers. Method Patients diagnosed with a splenic flexure cancer were identified from the 2012–2018 ACS-NSQIP colectomy-targeted database. Patients were categorized based on type of surgical resection – left hemicolectomy with colorectal anastomosis or segmental colectomy with colocolonic anastomosis. Demographic, clinicopathologic, and post-operative outcomes were compared between groups. Factors independently associated with lymph node harvest, operative time, and post-operative morbidity were investigated by linear and binomial logistic regression models. Results A total of 3,049 patients underwent colectomy for a splenic flexure cancer. Of these, 83.6% had a segmental colectomy and 73% were performed by a minimally invasive approach. T- and N-stage did not differ between segmental and left hemicolectomy groups (p = 0.703 and p = 0.429, respectively). Inadequate nodal harvest (< 12 nodes) was infrequent and similar between the two procedures (7.4% vs. 9.1%, p = 0.13). Operative time was significantly shorter for segmental colectomy (213 ± 83.5 min vs. 193 ± 84.1 min, p < 0.0001) and major morbidity was similar between the two surgical techniques (8.4% vs. 8.9%, p = 0.75). After accounting for demographic, clinicopathologic, and operative factors, binomial logistic regression showed that type of procedure was not significantly associated with LN harvest (OR 0.80, 95%CI 0.54–1.17) or major morbidity (OR 1.17, 95%CI 0.36–3.81). However, on linear regression, segmental splenic flexure resection was associated with shorter operative time (estimate 20.29, 95%CI 12.61–27.97, p < 0.0001). Conclusion Splenic flexure resection for colon cancer is associated with an adequate lymph node harvest. Compared to a formal left hemicolectomy, a segmental resection also has a shorter operative time with equivalent post-operative morbidity.

Isolated jejunal necrosis following corrosive acid poisoning

Corrosive acid poisoning is common in Asian countries, and most of the time, it is of suicidal intent in adults. Commonly they lead to extensive injuries of the upper gastrointestinal tract, and isolated involvement of the lower gastrointestinal tract is rare. We present a 35-year-old male who presented to us with a history of corrosive acid ingestion mixed with alcohol. Imaging did not demonstrate any pneumoperitoneum. The patient underwent exploratory laparotomy and found to have isolated jejunal necrosis without any evidence of injury to the stomach and duodenum. Segmental resection and end-to-end anastomosis were done.

Limb salvage surgery for giant cell tumours around knee joint: a single institute experience

<p class="abstract"><strong>Background:</strong> Giant cell tumours (GCTs) of bone are benign but locally aggressive tumours. The surgical treatment of GCTs in the around knee joint mainly includes curettage and bone grafting, extended curettage and cement filling, segmental resection and modular endo prosthesis reconstruction.</p><p class="abstract"><strong>Methods:</strong> Retrospective analysis of the presentation, the functional outcome following modular endoprosthetic reconstruction, prosthetic survival and the recurrence rate in 17 patients with Campanacci grade 3 GCTs involving distal femur and proximal tibia, who underwent segmental resection and modular endoprosthesis reconstruction in a single centre from 2015 to 2018. The surgery was performed according to the general principles of limb salvage surgery and modular segmental replacement was used. All stems were cemented in place. Isometric exercises and mobilization with crutches were started on 2^nd postoperative day. Knee joint bending was started for proximal tibia patients after 2 to 3 weeks. Functional outcome was scored by musculoskeletal tumour society scoring (MSTS). Immediate post-operative complication like delayed wound healing, flap necrosis, wound infection, foot drop, leg length discrepancies were evaluated.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average MSTS functional score was 78%.3 year prosthetic survival was 100%. None of the patients had recurrence. One patient had left lower lobe metastasis for which wedge resection was done.</p><p class="abstract"><strong>Conclusions:</strong> Segmental resection and endoprosthetic replacement has good functional outcome in patients with tumours around the knee joint. As GCTs are tumours with less chance of local and distant metastasis after complete excision, endoprosthetic prosthesis is a good treatment option after complete excision.</p>

Guide Flange Prosthesis with Acrylic Guidance Ramp for Management of Deviation following Segmental Mandibulectomy and Partial Maxillectomy for Gingivobuccal Mucosal Cancer: A Case Report.

Surgical resection of maxilla and /or mandible due to the presence of benign or malignant tumor is most common. Segmental resection frequently causes deviation of mandible towards the defective side and disturbances in maxillomandibular relationship. Variety of materials and techniques have been used for the construction of prosthetic replacement of acquired surgical defects. This case report describes prosthodontic management of a patient who has undergone partial maxillectomy and segmental mandibulectomy using the mandibular guide flange prosthesis with acrylic guidance ramp. This not only helps to correct the deviation but also guides the mandible for achieving occlusal contact with opposing teeth.

SURGICAL TECHNIQUES FOR THE TREATMENT OF RECTAL ENDOMETRIOSIS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS AND OBSERVATIONAL STUDIES

ABSTRACT BACKGROUND Endometriosis is a common disease in reproductive-age women and it is estimated to occur in up to 50% of those with infertility. Intestinal involvement is reported in up to a third of the cases. This condition is related to chronic pain and loss of quality of life, resulting in emotional, social and economic costs. Treatment consists of hormonal block and surgical resection, with variable side effects and efficacy. The best choice for surgical treatment for rectal endometriosis is a matter of discussion regarding the indication and the best technique to be employed. OBJECTIVE To summarize data on indications, results and complications of surgical techniques for the treatment of rectal endometriosis. METHODS: This comprehensive systematic review is a compilation of the available literature and discussion, carried out by a team with experience in the surgical treatment of intestinal endometriosis. Data regarding indications, results and complications of conservative and radical techniques for the surgical treatment of rectal endometriosis was carefully reviewed. Searches of PubMed, EMBASE, and CENTRAL up to May 2021 were performed to identify randomized controlled trials (RCTs) and observational studies that compared at least two of the three surgical techniques of interest (i.e., shaving, discoid resection, segmental resection). RESULTS: One RCT and nine case series studies with a total of 3,327 patients met the eligibility criteria. Participants ages ranged from a mean of 30.0 to 37.9 years old. Mean follow-up ranged from 1.2 to 42.76 months. With regards the methodological quality, overall the included studies presented a low risk of bias in the majority of the domains. Surgical treatment of rectal endometriosis is indicated for patients with obstructive symptoms and those with pain scores above 7/10. Patients with disease involving beyond muscularis propria of the rectum, documented in magnetic resonance imaging or transvaginal pelvic ultrasound with intestinal preparation, are candidates for discoid or segmental resection. The presence of multifocal disease, extension greater than 3 cm and infiltration greater than 50% of the loop circumference favor the radical technique. The distance from the lesion to the anal verge, age, symptoms and reproductive desire are other factors that influence the choice of the technique to be employed. The risk of complications and unfavorable functional results seems to be directly related to the complexity of the procedure. CONCLUSION: The choice of surgical technique performed for the treatment of rectal endometriosis is a matter of discussion and depends not only on the preoperative staging, but also on the patient’s expectations, risks and potential complications, recurrence rates and the expertise of the multidisciplinary team.

Clinical Application of Three-Dimensional Reconstruction Technique in Thoracoscopic Pneumonectomy

Objective. To investigate the clinical value of 3D computed tomography bronchoangiography (3D CTBA) in thoracoscopic anatomical lung segment resection or combined lung segment resection. Methods. The clinical data of 25 patients with non-small-cell lung cancer who underwent thoracoscopic radical lobectomy and pulmonary segmentectomy with pulmonary nodules were retrospectively analyzed. All patients underwent preoperative thin-slice CT scan, and the bronchus, pulmonary artery, and pulmonary vein were reconstructed by DeepInsight software. Meanwhile, pulmonary nodules, tumors, or enlarged lymph nodes were reconstructed. Accurate preoperative planning was carried out through preoperative reconstruction of three-dimensional images, especially the variation of pulmonary bronchus and blood vessels, the relationship between tumors and enlarged lymph nodes and pulmonary blood vessels, and the precise positioning of pulmonary nodules in pulmonary segments. Compared with preoperative three-dimensional reconstruction, intraoperative real-time navigation can achieve accurate operation. The intraoperative conversion to thoracotomy, operative time, intraoperative bleeding and postoperative hospitalization time, drainage tube removal time and total drainage volume, and the incidence of perioperative complications were recorded. Results. The anatomical structure and variation of bronchus and pulmonary vessels were clearly reconstructed in all patients, and the reconstruction of the relationship between central tumor and enlarged lymph nodes and blood vessels was satisfactory. The location of pulmonary nodules in pulmonary segments was clearly defined, and preoperative planning was performed accurately. All patients underwent real-time intraoperative navigation, and precise surgery was performed according to the preoperative planning. The operation was successfully completed without any transfer to thoracotomy or intraoperative accidental bleeding. The operative time was (147.60 ± 37.77) min, the intraoperative blood loss was (33.82 ± 22.17) mL, the postoperative hospital stay was (7.02 ± 1.78) d, drainage tube removal time was (4.68 ± 1.60) d, and postoperative total drainage volume was (221.00 ± 135.03) mL; there were no severe complications and no death during perioperative period. Conclusion. The application of three-dimensional reconstruction technique for preoperative evaluation and subsequent thoracoscopic pulmonary segmental resection can achieve accurate, safe, and effective pulmonary segmental resection, reduce the difficulty of thoracoscopic pulmonary segmental resection, reduce the risk of surgery, and improve the surgical effect.