Surgical Oncology

ASO Author Reflections: An Optimal Biological Model for Successful Drug Discovery

ASO Author Reflections: Surgical Treatment for Male Breast Cancer in the Modern Era

Laparoscopic Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (L-CRS/HIPEC) for Perforated Low-Grade Appendiceal Mucinous Neoplasm (LAMN II) Abstract Introduction Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established treatment for pseudomyxoma peritonei resulting from a perforated low-grade appendiceal mucinous neoplasm (LAMN II). In patients with localized disease, a laparoscopic procedure (L-CRS/HIPEC) can be undertaken. Methods This video demonstrates L-CRS/HIPEC in a 66-year-old male who had previously undergone an appendicectomy for an LAMN II lesion. The preoperative computed tomography (CT) scan suggested disease localized to the right iliac fossa. However, laparoscopic assessment unexpectedly revealed disease in the pelvis and on the right hemidiaphragm and liver surface. Results A technique for treating the thin film of mucin in the pelvis and on the right hemidiaphragm is demonstrated. The liver is mobilized to facilitate ablation of mucin on the serosal surface of the right lobe. Tips and tricks for starting the omentectomy, dealing with the vascular pedicle, and completing the dissection in the left upper quadrant are shown. The Peritoneal Cancer Index (PCI) score was 5 (3 for the right upper quadrant, 1 for the pelvis, 1 for the small bowel), and the cytoreduction score was CC-1. The operative duration was 8.5 h, and length of hospital stay was 5 days. The patient returned to work after 6 weeks. Discussion L-CRS/HIPEC can be performed when patients are unexpectedly found to have disease, provided the appendiceal pathology is low grade and the PCI score is low. There are potential benefits to this approach, with a shorter length of hospital stay and faster functional recovery when compared with traditional open surgery.

The Best Approach to Esophagectomy: Do We Know Yet?

Intrahepatic Cholangiocarcinoma: Rising Burden and Glaring Disparities

Pure Laparoscopic Anatomical Segment V Resection Using the Extrafascial and Transfissural Glissonean Approach Abstract Background The Glissonean approach is a widely used, effective technique for anatomical segmentectomy using an open or laparoscopic approach.1–4 In the extrafascial Glissonean approach, the deep tertiary branches of the right anterior portal pedicle may be difficult to dissect from the liver hilum.5,6 We present a pure laparoscopic anatomical segment V resection using the extrafascial and transfissural Glissonean approach. Methods A 49-year-old man presented with a single mass in segment 5 of the liver. (1) Dissection of the right anterior portal pedicle: the right anterior portal pedicle was dissected meticulously. After temporary clamping of the pedicle, the main and right portal fissure were delineated. (2) Opening of the main and right portal fissure: the main and right portal fissure were opened for approaching the deep tertiary segment V portal pedicle.7,8 (3) Dissection of the segment V portal pedicle: the segment V portal pedicle was dissected and the segment V territory was confirmed. After dissection of the segment V hepatic vein, the remnant liver parenchyma was transected. Results The operation time was 280 min, the estimated blood loss was 80 mL, and the total Pringle maneuver time was 45 min. Final histopathological diagnosis showed a 2.8 cm-sized hepatocellular carcinoma with negative resection margin. The patient was discharged on postoperative day 6 without any complications. Conclusion The extrafascial and transfissural approach in laparoscopic anatomical segment V resection is feasible and effective, and allows easy and direct access to the segment V portal pedicle.

Longer Intervals from Neoadjuvant Therapy to Rectal Cancer Surgery: The Clock is Ticking…

ASO Author Reflections: Routine Lymphadenectomy Should be Recommended Regardless of Morphologic Subtype of Intrahepatic Cholangiocarcinoma

Salvage Surgery for Jejunal Necrosis After a Free Jejunal Transfer

It Is Time

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com