Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

BackgroundTo determine shortâ and longâ term oncologic outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for the treatment of pancreatic neuroendocrine tumor (pNET).MethodsThe data of the patients who underwent curative MIDP or ODP for pNET between 2000 and 2016 were collected from a multiâ institutional database. Propensity score matching (PSM) was used to generate 1:1 matched patients with MIDP and ODP.ResultsA total of 576 patients undergoing curative DP for pNET were included. Two hundred and fourteen (37.2%) patients underwent MIDP, whereas 362 (62.8%) underwent ODP. MIDP was increasingly performed over time (2000â 2004: 9.3% vs 2013â 2016: 54.8%; Pâ <â 0.01). In the matched cohort (nâ =â 141 in each group), patients who underwent MIDP had less blood loss (median, 100 vs 200â mL, Pâ <â 0.001), lower incidence of Clavienâ Dindoâ â ¥â III complications (12.1% vs 24.8%, Pâ =â 0.026), and a shorter hospital stay versus ODP (median, 4 versus 7 days, Pâ =â 0.026). Patients who underwent MIDP had a lower incidence of recurrence (5â year cumulative recurrence, 10.1% vs 31.1%, Pâ <â 0.001), yet equivalent overall survival (OS) rate (5â year OS, 92.1% vs 90.9%, Pâ =â 0.550) compared with patients who underwent OPD.ConclusionPatients undergoing MIDP over ODP in the treatment of pNET had comparable oncologic surgical metrics, as well as similar longâ term OS.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150595/1/jso25481_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150595/2/jso25481.pd

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.Peer reviewe

WSES guidelines for emergency repair of complicated abdominal wall hernias

Peer reviewe

Single center preliminary experience with endoscopic submucosal dissection for early gastrointestinal cancers

INTRODUCTION: ESD is a new and more radical treatment for early GI cancers providing high rates of “en bloc” resection compared with EMR. In contrast to Japan, the treatment of these tumors in the West is still mainly surgical. Herein, we report our preliminary experience with the ESD technique. AIMS & METHODS: Ten patients (6 M, 4 W; mean age 70.7 yrs) underwent endoscopic resection of their early cancers from March 2007 to April 2008. Lesions were in: gastric fundus (1), body (2), antrum (2); cecal fundus (1), transverse colon (1), left colon (2), rectum (1). The mean size was 21 mm. Biopsies revealed: HGD in the gastric tumors; focal HGD and LGD in the colorectal tumors. ESD was planned in OT under general anaesthesia, with back-up surgery in the event of complications. Indigo carmine (0.2%) and magnification (160x) defined the borders and the pit-pattern of the lesions. Only in the stomach, marking spots were made by needle- or hook-knife. NS plus adrenaline and IC was mainly used as injection fluid. An addition of hyaluronic acid (0.2%) was needed especially in the colon. After injection, a circumferential incision, 5 mm away from the margins of the lesion, was performed. The exposed SM layer was then dissected by It-knife using a lateral movement and sometimes in retrovision. In case of failure of “en bloc” removal, the final excision was achieved in few pieces with a polypectomy snare. Once retrieved, the specimen was fixed orientated on a board and sectioned in 2-mm intervals parallel to the closest resection margin to assess both lateral and vertical margins. RESULTS: The mean operating time was 107 minutes. Curative resection was achieved in 9 of 10 cases. Seven lesions were removed “en bloc”. In 3 cases, a “piecemeal” resection was used. In 1 case, a laparoscopic appendectomy was needed for extension of the cecal polyp to the appendiceal body. Histology revealed: intramucosal ADC in the fundic EGC; HGD in the 4 body-antrum lesions; LGD with focal HGD in the 5 colorectal tumors. In all the lesions but one, the lateral and vertical margins were free of tumor. Intraoperative bleeding was arrested by It-knife or coagrasper in any case. In 1 case only, in the left colon, delayed bleeding occurred and was conservatively managed. Perforation occurred in 2 colonic ESD, but was immediately recognized and closed by clips. At a mean FU of 4 months, no recurrence was observed. CONCLUSION: In our experience, ESD has been performed successfully in the majority of cases without major complications. ESD should be considered as elective treatment for early GI cancers as long it is performed under the right indications. More experiences are needed to strengthen the performance capacity