简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：AbstractBackground:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long-term and large scale outcomes data.Objective:The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.Methods:In accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.Results:Forty-four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy-two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6-83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5-year follow-up, reported overall survival was 91.1%.Conclusion:Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5-year survival is 91.1%.

简介：AbstractNew discoveries based on genetic and epigenetic evidence have significantly expanded the understanding of diffuse gliomas. Molecular biomarkers detected in diffuse gliomas are not only potential targets for radiotherapy, chemotherapy, and immunotherapy, but are also able to guide surgical treatment. Previous studies have suggested that the optimal extent of resection of diffuse gliomas varies according to the expression of specific molecular biomarkers. However, the specific guiding role of these biomarkers in the resection of diffuse gliomas has not been systemically analyzed. This review summarizes several critical molecular biomarkers of tumorigenesis and progression in diffuse gliomas and discusses different strategies of tumor resection in the context of varying genetic expression. With ongoing study and advances in technology, molecular biomarkers will play a more important role in glioma resection and maximize the survival benefit from surgery for diffuse gliomas.

简介：ObjectivesConventionalapproachesforremovaloflateralskullbasetumors,includingtransmandibular,infratemporalfossa,preauriculartranszygmaticsubtemporalapproaches,aremajorinvasiveproceduresthatoftensacrificehearingandcauseabnormalocclusionandcosmeticdefects.Reportsofthetranscervicalapproachforresectionofskullbasetumorsarerare,althoughitwasdescribedforresectionofclivalchordomasinasearlyas1966.Thepurposeofthisstudyistoreviewourexperiencesinmanagementoflateralskullbasetumorsusingthetranscervicalapproach.StudyDesignRetrospectivechartreview.MethodsSixlateralskullbasetumorcasestreatedwithtranscervicalapproachprocedureswerereviewed,includingthemedicalrecords.ResultsTherewere4malesand2females.Agerangedfrom12through52years.Histopathologicaldiagnosesincludedmalignantschwannoma(n=1),malignantcarotidbodytumor(n=1),heamangioma(n=1),schwannoma(n=2)andpleomorphicadenoma(n=1).Transcervicaltechniqueswereusedinallcaseswiththeuseofmicroscopeinthelateralskullbasearea.Completetumorremovalwasachievedinallcases.Postoperativeradiotherapywasimplementedin1caseofmalignantschwannomaand1caseofmalignantcarotidbodytumor.Jugularforamensyndromeoccurredasasurgicalcomplicationin1caseofmalignantSchwannomaofthevagusnerve.Therewasnotumorrecurrenceduringthe10-42monthfollow-upperiod.ConclusionComparedwithconventionalapproaches,thetranscervicalapproachprovidesaeasy,safe,minimalinvasiveandeffectiveprocedureforremovalofselectedlateralskullbasetumors.

简介：Duringthepastdecade,roboticsurgicalsystemshavebeenincreasinglyutilizedtoperformhighlycomplexsurgicalprocedures.Infact,therobotic-assistedapproachtothetreatmentofmanygynecologicalandurologicalsurgicalprocedureshasbecomethestandard-of-care.Theuseofroboticsurgicalsysteminthoracicsurgeryisinitsearlydevelopment.Video-assistedthoracoscopicsurgery(VATS)

简介：ChildsNervSyst.2008Jun18.OBJECTIVES:Despiterevolutionarytechnicaladvancementinneuroimagingandoperativeneurosurgery,surgicalextirpationoffocalbrainstemglioma(BSG)remainssteepedincontroversy.Inthisstudy,weevaluatedourseniorauthor's(CT)surgical

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简介：Objective:Toreportasurgicalmethodforthetreatmentofpre-auricularfistulatolowerpost-operativerecurrencerate.Methods:Clinicaldataof187patientswithpre-auricularfistulawhounderwentenblocresectionattheAffiliatedHospitalofLuzhouMedicalCollegefromAugust2006toNovember2012wereretrospectivelyreviewed.FactorsthatmightaffecttheprognosisfollowingEnblocfistularesectionborderedbythesuperficialtemporalisfascia,helixperichondriumandauriculocephalicsulcuswereinvestigated.Results:Ofthe187patients,181achievedprimaryhealingand6endedupwithdelayedhealing.Duringthefollow-upperiod(onetosevenyears),therewere4casesofrecurrence(2.1%).Conclusions:Cleardemarcationofsurgicalresectioncanfacilitateeasyandthoroughresectionofpreauricularfistulaandleadtolowrecurrencerate.Propertimingandcarefulsearchforpotentialfistulabranchesarethetwocrucialfactorsaffectingprognosis.

简介：AIMTounderstandtheinfluenceoffrailtyonpostoperativeoutcomesforlaparoscopicandopencolectomy.METHODSDatawereobtainedfromtheNationalSurgicalQualityImprovementProgram(2005-2012)forpatientsundergoingcolonresection[opencolectomy(OC)andlaparoscopiccolectomy(LC)].Patientswereclassifiedasnon-frail(0points),lowfrailty(1point),moderatefrailty(2points),andseverefrailty(≥3)usingtheModifiedFrailtyIndex.30-dmortalityandcomplicationswereusedastheprimaryendpointandanalyzedfortheoverallpopulation.Complicationsweregroupedintomajorandminor.Subsetanalysiswasperformedforpatientsundergoingcolectomy(totalcolectomy,partialcolectomyandsigmoidcolectomy)andseparatelyforpatientsundergoingrectalsurgery(abdominoperinealresection,lowanteriorresection,andproctocolectomy).WeanalyzedthedatausingSASPlatformJMPProversion10.0.0(SASInstituteInc.,Cary,NC,UnitedStates).RESULTSAtotalof94811patientswereidentified;themajorityunderwentOC(58.7%),werewhite(76.9%),andnon-frail(44.8%).Themedianagewas61.3years.Prolongedlengthofstay(LOS)occurredin4.7%,and30-dmortalitywas2.28%.PatientsundergoingOCwereolder(61.89±15.31vs60.55±14.93)andhadahigherASAscore(48.3%ASA3vs57.7%ASA2intheLCgroup)(P<0.0001).Mostpatientswerenon-frail(42.5%OCvs48%LC,P<0.0001).Complications,prolongedLOS,andmortalityweresignificantlymorecommoninpatientsundergoingOC(P<0.0001).OChadahigherriskofdeathandcomplicationscomparedtoLCforallfrailtyscores(non-frail:OR=4.7,andOR=4.67;mildlyfrail:OR=2.51,andOR=2.47;moderatelyfrail:OR=2.94,andOR=2.02,severelyfrail:OR=2.37,andOR=2.34,P<0.05)andanincreaseinabsolutemortalitywithincreasingfrailty(non-frail0.68%OC,mildlyfrail1.39%,moderatelyfrail3.44%,andseverelyfrail5.83%,P<0.0001).CONCLUSIONLCisassociatedwithimprovedoutcomes.Althoughtheoddsofmortalityarehigherin

简介：BACKGROUND&OBJECTIVE:Themajorityofintramedullaryspinalcordtumors(IMSCT)arelow-gradegliomas.RadicalresectionforIMSCTsremainschallenging.Recently,improvedneuroimagingandadvancedmicrosurgicaltechniquehavemadegreatsuccessinsurgicalmanagementoftheintramedullaryspinalcordtumors.METH-ODS&RESULTS:Twenty-ninepatientswithintramedullaryspinalcordtumorsweretreatedbyradicalresectiondur-ingthepast4yearsinourinstitute.Thehistologicalresultswereasfollows:12ependymomas,4astrocytomas,4heman-gioblastomas,4epidermoids,1cavernoma,2lipomas,2metastatics.Agross-totalresection(>95%)wasachievedin25surgicalprocedures.Subtotalresections(80-95%)wereperformedin4cases.Therewasnosurgicaldeath.Whencomparingthepreoperativeand3-monthpostoperativefunctionalgrades,12patientswerestable14improved,and3deteriorated.Patientswitheithernodeficitoronlymilddeficitbeforesurgerywererarelyimpairedbytheproce-dure,reinforcingtheimportanceofearlydiagnosisandtreatment.Themajordeterminantoflong-termsurvivalwashistologi-calcompositionofthetumor.PatientsinwhomanIMSCTwasonlypartiallyresected(<80%)faredsignificantlyworse.CONCLUSIONS:Thelong-termsurvivalandqualityoflifeforpatientswithlow-gradegliomastreatedbyradi-calresectionaloneiscomparableorsuperiortominimalresectionplusradiotherapy.Theoptimaltherapyforpatientswithhigh-gradegliomaisyettobedetermined.Forbenignlesion,suchashemangioblastomaandcavernomacouldbecuredbytotalresectionofthetumor.Forlipomaandepidermoid,fibrousadhesionstothecordmaketotalremovaldifficult,andthus,removalisnotthegoalofsurgery.Thecarbondioxidelaserisparticularlyusefulduringsurgeryforthislesion.

简介：AbstractBackground:Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors (GISTs) (diameter ≤5 cm), the results remain conflicting. The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs. laparoscopic resection.Methods:The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched medical databases up to January 2020. Meta-analytical random or fixed effects models were used in pooled analyses. Meta-regression, cumulative meta-analyses, and sub-group analyses were performed to improve the accuracy of the conclusion. Sensitivity analyses were applied to assess the robustness of the results.Results:A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified, while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found. We found that endoscopic resection had shorter operation times (weighted mean difference [WMD]= -27.1 min, 95% confidence interval [CI]: -40.8 to -13.4 min) and lengths of hospital stay (WMD = -1.43 days, 95% CI: -2.31 to -0.56 days) than did laparoscopic resection. The results were stable and reliable. There were no significant differences in terms of blood loss, hospitalization costs, incidence of complications or recurrence rates. For tumor sizes 2 to 5 cm, endoscopic resection increased the risk of positive margins (relative risk [RR] = 5.78, 95% CI: 1.31-25.46). Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery (WMD = -41.03 min, 95% CI: -59.53 to -22.54 min), there was a higher incidence of complications (RR = 4.03, 95% CI: 1.57-10.34).Conclusions:In general, endoscopic resection is an alternative method for gastric GISTs ≤5 cm. Laparoscopic and endoscopic cooperative surgery may work well in combination. Further randomized controlled trials are recommended to validate or update these results.

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简介：Synchronousoccurrenceofepithelialneoplasiaandgastrointestinalstromaltumor(GIST)inthestomachisuncommon.Onlyrarecaseshavebeenreportedintheliterature.Wepresentherea60-year-oldfemalecaseofsynchronousoccurrenceofgastrichigh-levelintraepithelialneoplasiaandGISTwiththefeaturesof22similarcasesanddetailedinformationreportedintheEnglishlanguageliteraturesummarized.Inthepresentpatient,epithelialneoplasiaandGISTwereremovedenblocbylaparoscopicwedgeresection.Tothebestofourknowledge,thisisthefirstreportedcasetreatedbylaparo-scopicwedgeresection.

简介：AbstractThis article presents a case of low-grade cribriform cystadenocarcinomas (LGCCC), a rare salivary gland tumor manifesting in the infratemporal fossa (ITF). The lesion in this case is unique in its location, histopathology, and management in that the tumor resection was performed using an exclusively endoscopic, endonasal approach. This case highlights the expanding application of endoscopic skull base techniques to address an indolent, slow-growing malignancy of the ITF.

简介：Aim:ToverifywhetherpartialintraoperativeTenon'scapsuleresection(PTCR)withadjunctiveMitomycinCiseffectiveindevelopingthin,avascularblebsineyesundergoingAhmedglaucomavalveinsertionandtoassesstheefficacyandsafetyofthisprocedure.Methods:ThisstudywasconductedinfourLatinAmericacountries(Argentina,Brazil,ColombiaandPeru).AhmedglaucomavalveimplantinsertionwithPTCR(groupA)andwithoutPCTR(groupB)wasperformedinneovascular

简介：AbstractMany patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

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