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Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique
Safak Ozturk,
Mutlu Unver,
Burcin Kibar Ozturk,
Osman Bozbıyık,
Varlık Erol,
Eyup Kebabcı,
Mustafa Olmez,
Cengiz Aydın,
Gökhan Akbulut
Issue:
Volume 2, Issue 2, April 2014
Pages:
21-23
Received:
25 February 2014
Published:
20 March 2014
DOI:
10.11648/j.js.20140202.11
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Abstract: Introduction: Hepatic metastasis is the most common form of distant spread of colorectal cancer (CRC) with about 50% occurrence rate. Liver resection (LR) with R0 margins is the only curative treatment and is believed to have improved the long-term out-come of these patients. Because of a chemotherapeutic injury to the liver, preservation of as much parenchymal volume as possible to minimize the risk of liver failure is the most important issue in these group of patients.Our present report describes a parenchyma preserving technique with left superior hepatectomy and segment 6 resection in a case. Case Report: A 64- year- old woman presented to our instution with a colorectal liver metastasis. PET-CT scan showed solitary liver lesions in segment 2-4a and 6. A left superior hepatectomy (segment 2 and 4a) and segment 6 resection was performed with glissonian approach and clemp-crush technique. Left hepatic vein was ligated without blocking the venous and biliary drainage of segment 4b and segment 3. Pathological examination of the specimen showed tumor-free margins (R0 resection). Discussion: Developments in imaging modalities provide an improved visualization of hepatic segmental anatomy and also provide volumetric calculation on the liver. This allows a successful planning for segmental liver resections with a minimum risk of postoperative liver failure. Factors that were considered contraindications for the surgery, such as number of metastases, tumor size, synchronous metastases and the presence of extrahepatic disease, must be evaluated as prognostic factors and must not prevent these patients opportunity of being treated. The main consideration is to achieve a complete R0 resection. A 1cm-R0 surgical margin width has been considered to avoid local intrahepatic recurrence and optimize long-term survival after hepatic resection for colorectal cancer metastases but tumor biology is a more important predictor for intrahepatic recurrence rather than milimetres. Conclusion: Preservation of as much parenchymal volume as possible in order to minimize the risk of liver failure is required in liver resections with chemotherapeutic liver injury. Drainage of the remaining liver segments into the retrohepatic vena cava via the retrohepatic veins and communicating veins between adjacent hepatic veins may allow adequate liver outflow and remaining functional liver parenchyma in selected cases with hepatic vein invasion.
Abstract: Introduction: Hepatic metastasis is the most common form of distant spread of colorectal cancer (CRC) with about 50% occurrence rate. Liver resection (LR) with R0 margins is the only curative treatment and is believed to have improved the long-term out-come of these patients. Because of a chemotherapeutic injury to the liver, preservation of as muc...
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A Rare Case of Transposition of Great Arteries with an Intact Septum and Aorto-Pulmonary Window
Sanjeev Singh,
Arti Singh,
Deigheidy Ehab Mahrous
Issue:
Volume 2, Issue 2, April 2014
Pages:
24-26
Received:
20 January 2014
Published:
30 March 2014
DOI:
10.11648/j.js.20140202.12
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Abstract: Transposition of the great arteries with an intact ventricular septum and aortopulmonary window is an extremely rare anatomic combination associated with high morbidity and mortality. We report a case of a 24days neonate with dextro-transposition of the great arteries with intact ventricular septum and a large aortopulmonary window as a mechanism of inter-circulatory mixing.
Abstract: Transposition of the great arteries with an intact ventricular septum and aortopulmonary window is an extremely rare anatomic combination associated with high morbidity and mortality. We report a case of a 24days neonate with dextro-transposition of the great arteries with intact ventricular septum and a large aortopulmonary window as a mechanism o...
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Lymph Node Harvest in Rectal Cancer Surgery Following Neoadjuvant Chemoradiotherapy
Kolitha Goonetilleke,
Rob Church,
Sarah Addison,
Steve Odogwu
Issue:
Volume 2, Issue 2, April 2014
Pages:
27-31
Received:
8 March 2014
Accepted:
8 April 2014
Published:
10 April 2014
DOI:
10.11648/j.js.20140202.13
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Abstract: Purpose: The purpose of the study is to investigate the effect of neoadjuvant chemoradiation, as well as clinicopathological features, on the yield of lymph nodes and survival in rectal carcinoma. Methods: We conducted a retrospective cohort study using an institutional database. 93 patients with rectal cancer treated with curative surgery from 2009 through 2012 at a single District General Hospital in the United Kingdom were included in the study. Follow up perioed was 4 years. Patients had neoadjuvant long course chemoradiotherapy if they were stage II or III. Results: A total of 93 patients were included. 51 received neoadjuvant therapy (NEO) before resection and 42 proceeded to surgery (SURG). There was less lymph node yield in patients who received neoadjuvant therapy (21 vs. 16, p < 0.05). Examination of pathology reports revealed that all patients in the NEO group had more nodes with metastatic disease compared to the SURG group (23 vs 18, p<0.05). The sphincter preservation rate was 83% for patients operated with neoadjuvant treatment versus 95 % for those in surgery group, Patients within the neoadjuvant group had a statistically significant higher number of APR (NEO 17% vs. SURG 5% vs. p<0.01). There was no survival advantage in the neoadjuvant group. Conclusion: Preoperative CRT is associated with a reduction in the yield of lymph nodes in rectal cancer surgery. This is mainly related to radiotherapy, which exerts its effects on the lymph nodes. Also factors such as sex and the level of the tumour may affect lymph node yield.
Abstract: Purpose: The purpose of the study is to investigate the effect of neoadjuvant chemoradiation, as well as clinicopathological features, on the yield of lymph nodes and survival in rectal carcinoma. Methods: We conducted a retrospective cohort study using an institutional database. 93 patients with rectal cancer treated with curative surgery from 200...
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Laparoscopic Treatment of Splenic Lymphangioma: A Rare Case in Adults
Mutlu Ünver,
Şafak Özturk,
Varlık Erol,
Eyüp Kebabcı,
Kamil Pehlivanoğlu,
Nihat Zalluhoğlu,
Mustafa Ölmez
Issue:
Volume 2, Issue 2, April 2014
Pages:
32-34
Received:
20 March 2014
Accepted:
9 April 2014
Published:
20 April 2014
DOI:
10.11648/j.js.20140202.14
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Abstract: Primary benign tumors of the spleen are extremely rare and account for less than 0.007% of all tumors identified upon surgery and autopsy. The differential diagnosis is extensive and includes lymphoma, infarction, septic embolism, metastases (melanoma, breast, ovarian and lung cancer), and splenic cysts.Splenic lymphangiomas are usually benign tumors that predominantly affect children, whereas only a few cases have been reported in adults. Splenic lymphangiomas are mostly asymptomatic; therefore, the final diagnosis should be based on a combination of clinical, radiological, and histopathological findings. Their prognosis is good but there is a remarkable high risk of splenic rupture. Aspiration, drainage and sclerosis are some of the conservative managements that are accompanied with a high risk of recurrence.Surgery is always the preferable definitive treatment. We report a case of splenic lymphangioma, and discuss both diagnostic and therapeutic aspect of laparoscopic splenectomy which is the more effective procedure in these kind of cases
Abstract: Primary benign tumors of the spleen are extremely rare and account for less than 0.007% of all tumors identified upon surgery and autopsy. The differential diagnosis is extensive and includes lymphoma, infarction, septic embolism, metastases (melanoma, breast, ovarian and lung cancer), and splenic cysts.Splenic lymphangiomas are usually benign tumo...
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Inflammatory Breast Cancer Misdiagnosed as Mastitis
W. M. Isichei,
M. A. Misauno
Issue:
Volume 2, Issue 2, April 2014
Pages:
35-37
Received:
13 March 2014
Accepted:
22 April 2014
Published:
10 May 2014
DOI:
10.11648/j.js.20140202.15
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Abstract: Background: Inflammatory breast cancer (IBC) is a rapidly progressive disease associated with high mortality in developing countries. The patients are managed for mastitis’s first and IBC becomes a diagnosis of exclusion after failed response to appropriate antibiotic therapy. This study was aimed at evaluating the outcome of management of IBC in North central Nigeria. Patients and method: This was a prospective analysis of consecutive patients presenting with breast cancer at the Abubakar Tafawa Balewa University teaching hospital Bauchi (ATBUTH) from January 2011 to December 2012. Results: A total of 52 breast cancers were managed, mean age was 31+/- 2years with an age range of 29 -33 years. There were 51 females and 1male (m: f = 51:1) with IBC accounting for 9(17.3 %) of them. Conclusion: IBC is frequently misdiagnosed as mastitis for various reasons and a high index of suspicion is required to clinch the diagnosis.
Abstract: Background: Inflammatory breast cancer (IBC) is a rapidly progressive disease associated with high mortality in developing countries. The patients are managed for mastitis’s first and IBC becomes a diagnosis of exclusion after failed response to appropriate antibiotic therapy. This study was aimed at evaluating the outcome of management of IBC in N...
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