The first case of splenic flexure volvulus treated with reduced port surgery using single-incision laparoscopy.

INTRODUCTION: Splenic flexure volvulus (SFV) is a rare disease. We encountered a case of SFV, caused by congenital anomalies and persistent constipation. CASE PRESENTATION: A 43-year-old woman with a 35-year history of persistent constipation presented to the emergency department with acute lower abdominal pain. She had no past surgical history, and her vital signs were stable. A contrast-enhanced computed tomography (CE-CT) scan confirmed the SFV diagnosis. We initially performed endoscopic repositioning. To prevent recurrence, a laparoscopic left hemicolectomy was then carried out using reduced port surgery (RPS). She experienced no postoperative complications and was discharged seven days post-surgery. DISCUSSION: While SFV is typically managed through endoscopic repositioning followed by definitive surgical intervention to prevent recurrence, we successfully employed RPS in this case. Patients with SFV might be prime candidates for RPS due to the non-attachment of the descending colon to the retroperitoneum. Additionally, since SFV is a benign condition that doesn't necessitate lymph node dissection, it aligns well with the capabilities of RPS. Postoperatively, the patient experienced improved constipation symptoms. We hypothesize that this SFV was a result of a combination of factors: intestinal over-length, chronic constipation, and the loose adhesion of the descending colon to the retroperitoneum. CONCLUSION: This case demonstrates that RPS can be efficacious in treating SFV.

Effect of hospital volume on long-term outcomes of laparoscopic gastrectomy for clinical stage I gastric cancer.

BACKGROUND: This study aimed to examine the effect of hospital volume on long-term outcomes of patients who underwent laparoscopic gastrectomy for clinical stage I gastric cancer. PATIENTS AND METHODS: A total of 420 patients with clinical stage I gastric cancer who underwent laparoscopic gastrectomy at our university hospital (high-volume group) and affiliated hospitals (low-volume group) were included in this study. Overall survival (OS) and cause-specific survival (CSS) rates were analyzed. RESULTS: No significant differences were observed in the number of lymph nodes retrieved (29.9 vs. 27.7, p=0.21) and CSS between the high- and low-volume groups (p=0.92), although the OS rate in the low-volume group was significantly less than that in the high-volume group (p=0.045). CONCLUSION: These results indicate no clinical impact of hospital volume on prognosis of patients who underwent laparoscopic gastrectomy for clinical stage I gastric cancer when performed by surgeons with sufficient experience in open gastrectomy.

Phase II trial of combined regional hyperthermia and gemcitabine for locally advanced or metastatic pancreatic cancer.

PURPOSE: Despite advances in cancer therapy, treating pancreatic cancer remains one of the major challenges in the field of medical oncology. We conducted this phase II study to evaluate the efficacy and safety of regional hyperthermia combined with gemcitabine for the treatment of unresectable advanced pancreatic cancer. METHODS: Eligibility criteria included histologically proven, locally advanced or metastatic pancreatic cancer. Gemcitabine was administered intravenously at a dose of 1000 mg/m(2) on days 1, 8, and 15 every 4 weeks. Regional hyperthermia was performed once weekly, 1 day preceding or following gemcitabine administration. The primary end point was the 1-year survival rate. Secondary objectives were determination of tumour response and safety. RESULTS: We enrolled 18 patients with advanced pancreatic cancer between November 2008 and May 2010. The major grade 3-4 adverse events were neutropenia and anaemia; however, there were no episodes of infection. The objective response rate (ORR) and disease control rate (ORR + stable disease) were 11.1% and 61.1%, respectively. Median overall survival (OS) was 8 months, and the 1-year survival rate was 33.3%. Median OS of patients with locally advanced pancreatic cancer was 17.7 months. CONCLUSIONS: Regional hyperthermia combined with gemcitabine is well tolerated and active in patients with locally advanced pancreatic cancer.