Long-term outcomes of single-incision versus multiport laparoscopic totally extra-peritoneal inguinal hernia repair: a single-institution experience of 186 consecutive cases.

PURPOSE: This retrospective study was conducted to compare the long-term outcomes of single-incision totally extraperitoneal (S-TEP) inguinal hernia repair and conventional multiport totally extraperitoneal (M-TEP) inguinal hernia repair. METHODS: The study population included 186 consecutive patients (S-TEP, n = 149; M-TEP, n = 37) who underwent elective surgery for inguinal hernia at Osaka Police Hospital between 2011 and 2013. RESULTS: No significant between-group difference was found in patient or hernia characteristics or in perioperative outcomes, with the exception of age (S-TEP group vs. M-TEP group: median 69 [IQR 60-75] years vs. 64 [55-69] years, respectively; P = 0.019). Furthermore, no significant between-group difference was found in follow-up time (5.5 [3.0-5.8] vs. 5.4 [3.1-5.7] years, P = 0.839), recurrence rate (0.6 vs. 2.4%, P = 0.358), chronic pain (1.2 vs. 0%, P = 1.000), feeling the mesh (2.3 vs. 7.1%, P = 0.142), or movement limitation (0.6 vs. 0%, P = 1.000). All chronic symptoms were "mild but not bothersome." A metachronous contralateral inguinal hernia developed in 8.1% of patients. CONCLUSION: The long-term outcomes of S-TEP repair were comparable to those of M-TEP, with rates of recurrence, chronic pain, feeling the mesh, and movement limitation falling within acceptable limits.

[Single-Incision Laparoscopic Colectomy for Descending Colon Cancer in a Patient with a Horseshoe Kidney].

A 67-year-old woman presented with bloody stools to a local physician. Lower gastrointestinal endoscopy revealed a type 3 all-circumferential tumor at descending colon. She was diagnosed with descending colon cancer and referred to our hospital for surgery. Preoperative computed tomography(CT)revealed a horseshoe kidney. We performed single-incision laparoscopic colectomy for descending colon cancer(cT3cN0cM0, cStageⅡa)complicated by a horseshoe kidney. The surgery was performed safely without any additional injuries. In patients with horseshoe kidneys, abnormalities have been reported in the running of the blood vascular system and the renal pelvis and ureter systems. Thus, sufficient understanding of the anatomic abnormality by preoperative examinations, such as 3D-CT, is essential for performing surgery safely.

[A Comparative Study on Feasibility of SOX Therapy and SP Therapy with Short Hydration for Gastric Cancer in the Outpatient Setting].

We conducted a retrospective comparative study on feasibility of S-1/oxaliplatin(SOX)therapy and S-1/cisplatin therapy with short hydration(SP-SH)for gastric cancer in the outpatient setting. The subjects were patients with gastric cancer aged younger than 75 years who underwent SOX or SP-SH therapy at our hospital. There were 22 patients in the SOX group and 30 patients in the SP-SH group. Both the groups received the first course during hospitalization and then received the subsequent courses in the outpatient section. Evaluation items for each therapy included the treatment rate in the outpatient setting, number of re-hospitalization cases, relative dose intensity(RDI), and adverse events. The treatment rate in the outpatient setting was 100%(22/22)in the SOX group and 96%in the SP-SH group(26/27). Re-hospitalization cases included 1 case of loss of appetite in the SOX group and 1 cases of loss of appetite and 2 cases of febrile neutropenia(FN)in the SP-SH group. The median values of the RDI were 86% with S-1 and 85% with oxaliplatin in the SOX group and 92% with S-1 and 80% with cisplatin in the SP-SH group. The SP-SH group had a higher proportion of neutropenia cases of Grade 3 or higher(SP-SH 33% v. s SOX 5%, p=0.012). The SOX group showed a higher proportion of loss of appetite cases for all the Grades(SOX 86% v. s SP-SH 50%, p=0.007)and peripheral neuropathy cases(SOX 64% v. s SP-SH 23%, p=0.003). It was considered that SOX and SP-SH therapies can be treated in the outpatient section, although the occurrence of loss of appetite and FN must be considered.

Primary Intrahepatic Squamous Cell Carcinoma with Histological Collision of Adenocarcinoma and Squamous Cell Carcinoma: A Case Report.

BACKGROUND Cholangiocarcinoma is a rare, aggressive biliary tract malignancy. On histopathology, most tumors are adenocarcinomas, while squamous cell carcinoma of the biliary tract is extremely rare. CASE REPORT An 82-year-old male was admitted due to the detection of a space-occupying lesion at S6 of the liver. On abdominal dynamic computed tomography, there was an irregular mass with inhomogeneous density associated with mild delayed enhancement in the tumor's peripheral zone, measuring approximately 22×25 mm, at S6, with secondary dilated biliary ducts of B6. Endoscopic retrograde cholangiopancreatography showed a severe stricture at B6. Brush cytology of B6 was positive for both adenocarcinoma and squamous cell carcinoma. Furthermore, mucous brushing cytology of the papilla of Vater was also positive for adenocarcinoma. Finally, the preoperative diagnosis of primary intrahepatic cholangiocarcinoma, combined with a cancer of the papilla of Vater, was made. The patient underwent both extended right lobectomy and pancreaticoduodenectomy. Histological examination showed that the majority (>99%) of this liver tumor was composed of keratinizing squamous cell carcinoma. CONCLUSIONS Squamous cell carcinoma of the biliary tree is very rare, since the majority of biliary tree tumors are adenocarcinomas. Cholangiocarcinoma containing a squamous cell component has a poor prognosis. To the best of our knowledge, this is the first case report of a primary intrahepatic squamous cell carcinoma that presented as a solid tumor showing clear histological collision between adenocarcinoma and squamous cell carcinoma and was successfully treated with hepatic resection and achieved disease-free survival of more than one year.