Surgical outcomes of totally extraperitoneal repair for inguinal hernia: A retrospective multicenter propensity score-matched study.

BACKGROUND: Laparoscopic surgical approaches, including total extraperitoneal repair (TEP), have been widely accepted for inguinal hernia repair in Japan. However, there are limited data regarding recurrence after TEP in Japan, given the limited versatility of this procedure. This study retrospectively evaluated the rates of hernia recurrence after TEP and open mesh repair at multiple Japanese centers. METHODS: This retrospective study evaluated 1917 patients who underwent inguinal hernia repair at 32 institutions in the Oita prefecture between January 2014 and December 2015. Eligible patients were grouped according to whether they underwent TEP (1011 patients) or open mesh repair (636 patients). Propensity score matching was performed 1:1 (total: 1076 patients, 538 patients from each group). The outcomes of interest were recurrence, morbidity, and postoperative recovery. RESULTS: The TEP and open mesh repair groups had similar baseline characteristics. After propensity score matching, there was no significant difference between the two groups in terms of recurrence rate (TEP: 0.5% vs open mesh repair: 1.0%, P = .375). However, the TEP group had significantly longer operating times (median: 70.2 min vs 65.0 min, P < .001), significantly less blood loss (0-5.1 mL vs 0-20.4 mL, P < .001), and significantly shorter postoperative hospital stays (median: 5.0 days vs 6.4 days, P < .001). The overall incidences of morbidity were 6.2% in the TEP group and 7.2% in the open mesh repair group (P = .535). CONCLUSION: This multicenter retrospective study with propensity score matching revealed that the recurrence rates were similarly low for TEP and open mesh repair of inguinal hernia. Thus, a well-trained surgical team could use TEP as a standard procedure.

[A recurrence after surgery for colon cancer with metastases of the liver and periaortic lymph nodes, with CR achieved by using bevacizumab+mFOLFOX6].

We have experienced and report here a case of postoperative recurrence of colon cancer with metastases in the liver and the periaortic lymph nodes, where we attained CR through combination therapy with bevacizumab+mFOLFOX6. The patient was a male aged 65. He had already had cecal cancer, metastasis in the para-aortic lymph nodes, and multiple hepatic metastases. The surgery involved right colon resection+partial hepatectomy as well as dissection of the para-aortic and the superior mesenteric lymph nodes. The postoperative stage was SSN3H1P0M1 (#216)-pStage IV. S-1+CPT-11 was chosen as an adjuvant therapy. The para-aortic lymph nodes at the level of renal hilus were found enlarged after 17 courses of the therapy. Hence bevacizumab+mFOLFOX6 was chosen for the first-line treatment. After 14 courses of the therapy, CR was proved on the RECIST standard. On continued chemotherapy, CR has been maintained at present, 2 years and 11 months after the surgery or 10 months after confirmation of CR.