Associations among ancestry, geography and breast cancer incidence, mortality, and survival in Trinidad and Tobago

Breast cancer (BC) is the most common newly diagnosed cancer among women in Trinidad and Tobago (TT) and BC mortality rates are among the highest in the world. Globally, racial/ethnic trends in BC incidence, mortality and survival have been reported. However, such investigations have not been conducted in TT, which has been noted for its rich diversity. In this study, we investigated associations among ancestry, geography and BC incidence, mortality and survival in TT. Data on 3767 incident BC cases, reported to the National Cancer Registry of TT, from 1995 to 2007, were analyzed in this study. Women of African ancestry had significantly higher BC incidence and mortality rates (Incidence: 66.96; Mortality: 30.82 per 100,000) compared to women of East Indian (Incidence: 41.04, Mortality: 14.19 per 100,000) or mixed ancestry (Incidence: 36.72, Mortality: 13.80 per 100,000). Geographically, women residing in the North West Regional Health Authority (RHA) catchment area followed by the North Central RHA exhibited the highest incidence and mortality rates. Notable ancestral differences in survival were also observed. Women of East Indian and mixed ancestry experienced significantly longer survival than those of African ancestry. Differences in survival by geography were not observed. In TT, ancestry and geographical residence seem to be strong predictors of BC incidence and mortality rates. Additionally, disparities in survival by ancestry were found. These data should be considered in the design and implementation of strategies to reduce BC incidence and mortality rates in TT

Three trocars laparoscopic right ileocolectomy for advanced small bowel neuroendocrine tumor

BACKGROUND: In the last decade Reduced Port Laparoscopy (RPL) has been introduced to reduce the risks related to the trocars and abdominal wall trauma, with enhanced cosmetic outcomes. The authors report a 59 year old man with a small bowel neuroendocrine tumor, submitted to three trocars right ileocolectomy. VIDEO: Preoperative work-up, including endoscopic ultrasound, octreo-PET-CT and FDG PET-CT, showed a 15 mm small bowel low grade well differentiated neuroendocrine tumor with mesenteric and transverse mesocolic extension, until the muscularis propria of the 3rd duodenum. The procedure was performed using three trocars: 12-mm in the umbilicus, 5-mm in the right and left flanks. After mobilization of the right colon, the 2nd and 3rd duodenal segments were exposed, showing tumor extension to the anterior duodenal wall. After encircling the anterior aspect of the duodenal wall with a piece of cotton tape, a linear stapler was inserted through the umbilical trocar under a 5-mm scope in the left flank, and it was fired. The specimen was removed through a suprapubic access. Frozen section biopsy showed free duodenal margin, hence the procedure was finished with handsewn intracorporeal ileocolic anastomosis. RESULTS: Operative time was 4 hours. No added trocars were necessary. Patient was discharged on 4th day. Pathology showed a grade I, well differentiated small bowel neuroendocrine tumor, with lymphovascular emboli and perinervous infiltration; 1/20 metastatic nodes, free margins; stage (8 UICC edition): pT3N1. At 12 months of follow-up the patient is free of disease. CONCLUSIONS: RPL offers all MIS advantages, including reduced trocar complications and enhanced cosmetic outcomes.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Laparoscopic Management of a Massive Splenic Cyst

Splenic cysts are relatively uncommon entities in surgical practice and treatment options vary. We present a case of a young adult woman who presented with a left-sided abdominal mass. A large splenic cyst was diagnosed by abdominal ultrasound and computed tomography. Laparoscopic partial excision with marsupialisation was performed with uneventful recovery and minimal blood loss. Histopathology revealed an epidermoid cyst of the spleen. This report describes the case, and includes a short review of the literature. Laparoscopic partial excision with marsupialisation is a safe and appropriate method of treatment for large splenic cysts

The three approaches to the colonic splenic flexure mobilization – a video vignette

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Simultaneous transanal endolaparoscopic resection of a large anal canal and low rectal polyps – a video vignette

SCOPUS: le.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Laparoscopic repair of a rare acquired abdominal intercostal hernia

INTRODUCTION: An acquired abdominal intercostal hernia (AIH) is a very rare and sporadically reported entity. Most cases of AIH are secondary to major trauma and the treatment of choice is surgical repair. PRESENTATION OF CASE: We present the case of a 58-year-old man who presented with a painless intercostal swelling, which started after previous penetrating trauma to the same area. Radiological assessment was done with CT scan and the hernia was repaired with a laparoscopic approach using mesh. DISCUSSION: AIH is a rare entity and trauma has an integral role in the pathophysiology. Surgical repair is the treatment of choice, however, due to the paucity of cases, there is no established method of choice for such repair. We present the first reported case in the Caribbean, which was repaired with the laparoscopic approach. CONCLUSION: Although AIH is a rare condition, the pathophysiology seems relatively straightforward and the use of CT scan is recommended to confirm the diagnosis. The laparoscopic approach, with all its established benefits, appears to be a safe and feasible option in its management

Simultaneous transanal endolaparoscopic resection of a large anal canal and low rectal polyps

SCOPUS: le.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Completely Intracorporeal Handsewn Laparoscopic Anastomoses During Whipple Procedure

Background: Whipple procedure has been described since 1935,1 using classic open surgery. With the advent of minimally invasive surgery (MIS), it has been described to be feasible using the latest technology.2,3 In this video the authors report a full laparoscopic Whipple procedure, realizing the three anastomoses by intracorporeal handsewn method. Video: A 70-year-old man who presented with adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma underwent to a laparoscopic Whipple. Preoperative work-up shows a T3N1M0 tumor. Results: No perioperative complications were registered. The pancreatico-jejunostomy was created in end-to-side fashion using two PDS 3/0 running sutures (Fig. 1), the hepatico-jejunostomy in end-to-side method using two PDS 4/0 running sutures (Fig. 2), and the gastro-jejunostomy in end-to-side method using two PDS 1 running sutures (Fig. 3). Total operative time was 8 h 20 min. Time for the dissection was 6 h 20 min, time for the specimen’s extraction was 20 min, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 h 40 min. Operative bleeding was 350 cc. Patient was discharged on postoperative day 9. Pathologic report confirmed the moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymphnodes on 23 isolated; 8 edition UICC stade: pT3bN1. Conclusions: Laparoscopic Whipple remains an advanced procedure to be performed by laparoscopy as well as by open surgery. All the advantages of MIS, such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using using laparoscopy.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A case report of the clear cell variant of gallbladder carcinoma

Introduction: Clear cell gallbladder carcinoma accounts for less than 1% of all gallbladder malignancies and demonstrates its unique histopathological characteristics in patients with no prior medical illness or familial predisposition. Presentation of case: Here we present a case of a 56-year-old female, with no prior medical conditions presented with a 2-month history of upper abdominal pain. Routine hematological and biochemical tests were unremarkable. An abdominal ultrasound revealed the presence of a gallbladder calculi, and a fundic mass while magnetic resonance cholangiopancreatography revealed a 8.0 cm × 3.5 cm gallbladder mass. Computed tomography imaging excluded any distant haematogenous metastases. An open cholecystectomy with lymphadenectomy was proceeded by staging laparoscopy. Upon pathologic investigation, the morphologic and immunophenotypic features supported a diagnosis of clear cell variant of gallbladder carcinoma. Discussion: Pathological prognostications for primary clear cell gall bladder carcinomas are not well defined due to the rarity of cases and possible misidentification as secondary metastases. Foci of adenocarcinoma within the tumor along with immunohistochemical staining probes can be informative in consideration of differential diagnosis. Conclusion: In these cases, clinical case management should be personalized for increased survival with the possible incorporation of next generation sequencing approaches to guide therapeutic algorithms. We discuss this exceedingly rare case of the clear cell variant of gallbladder carcinoma in detail, highlighting some of the diagnostic, and clinical challenges