Opportunities and challenges of parenchyma-preserving pancreatectomy in the era of laparoscopy and robot / 国际外科学杂志

The increasing incidence and early diagnosis of benign and low grade malignant tumor have presented new challenge to surgeons. Nowadays the safety of pancreatic surgery are warranted due to the progress of surgical techniques, resulting in the expansion of surgical indications. The long survival time post-operation of benign or low grade malignant tumors makes the preservation of endocrine and exocrine function of pancreas more and more important, and the parenchyma-preserving pancreatectomy has been increasing used at experienced medical center, including enucleation, central pancreatectomy and duodenum preserving pancreatic head resection. Compared with pancreaticoduodenectomy and distal pancreatectomy, significantly less patients suffered from endocrine and exocrine insufficiency after local resection of pancreas. More complications was observed after enucleation and duodenum preserving pancreatic head resection, mostly grade A pancreatic fistula, with low rate of mortality. Central pancreatectomy was associated with significantly more severe complications, compared with distal pancreatectomy. Laparoscopic or robotic local resection of pancreas are minimally invasive, and more suitable for the protection of main pancreatic duct with amplifying visions, and is more suitable for local resection of the pancreas than open surgery.

Dermatofibrosarcoma protuberance: a recrudescent dermal malignancy

Dermatofibrosarcoma protruberens is a rare soft tissue tumour of low malignant potential, commonly seen on the trunk and extremities. It is a slow growing sarcoma, with a tendency for recurrence. Rarely, it may be a high-grade tumour. It responds well to wide local excision. Radiotherapy is beneficial for margin positive and high-grade tumours. We present a case of a 22 years old male with a dermatofibrosarcoma protruberens presenting as a swelling over the left inguinal region since, 4 years, that was excised with a 2cm margin. Patient was followed up for six months without any recurrence.

Management of idiopathic granulomatous mastitis: a surgical experience of ten cases

Granulomatous mastitis is a chronic inflammatory condition of the breast that is rarely described in literature. It mimics breast abscess on clinical presentation giving dilemma to the surgeon. The etiology can be infectious, autoimmune or idiopathic. The various modalities of treatment for idiopathic granulomatous mastitis includes drainage of abscess, antibiotics and corticosteroid therapy. This is a case series of ten cases of diagnosed with granulomatous mastitis treated in the period of 2 years from 2018 and 2019 in Department of General Surgery, MGM Hospital Navi Mumbai. The data of all the patients were collected from records. They were following at regular intervals in the outpatient department to assess recurrence. The mean age of the patients was 41 years (range 26–47 years). Six patients gave history of breast-feeding in the last 5 years, one was lactating at the time of presentation. One of the patients was treated empirically for Tuberculous mastitis for the opposite breast. Others had no history suggestive of tuberculosis or other connective tissue diseases, such as rheumatoid arthritis or sarcoidosis USG breast was performed in all cases. Hypoechoic abscess was seen in 5 cases. The time taken for complete resolution of the disease was ranging from 2 weeks to 2 months. All patients had an uneventful recovery and no recurrences reported till now. GM is a rare benign breast disease that is difficult to distinguish from other inflammatory breast diseases or cancer. The diagnosis of GM must be based on a multidisciplinary approach. Surgical management followed by antibiotics was found to be sufficient to treat the condition in our patients. Corticosteroids need not be administered in all cases of this benign breast disease.

Melanoma of anal canal

Melanomas are primarily tumours of the skin, but rarely occur at other sites like retina and anal canal. Anorectal melanoma is an uncommon condition associated with a very poor prognosis. The patient usually presents with per rectal bleed or mass. These are often misdiagnosed on presentation. Diagnosis is confirmed by biopsy. Treatment is abdominoperineal resection or wide local excision if tumour free margins can be obtained. We present a case of a 60 years old female who presented to the outpatient department with per rectal mass and bleed since 4 to 5 months and was diagnosed with melanoma anal canal on biopsy. CT scan abdomen and pelvis was done. Patient underwent abdominoperineal resection as wide local excision with sphincter saving was not possible due to the location and extent of tumour as seen on CT scan. Patient had an uneventful recovery after the procedure.

A rare case of perineal endometriosis with anal sphincter involvement

Perineal endometriosis is a rare entity which can be explained by direct implantation of endometriotic cells over the fresh episiotomy wound and subsequent development of scar endometriosis. Perineal scar endometriosis incidence is reported to be 0.3% to 1%. 28 years old, P1L1, presented with pain and swelling near episiotomy site which is associated with menstruation. Examination during menstruation revealed swelling was tender, erythematous and slightly increased in size. Clinical diagnosis of scar endometriosis was made after clinical examination. Mass excised and sent for histopathological examination. Although diagnosis essentially remains clinical, preoperative evaluation with perineal ultrasound and MRI was performed. Wide local excision remains treatment of choice and follow up for recurrence is recommended. Histopathological examination is obligatory to exclude rare possibility of malignant changes.

Analysis of Surgical Resection and Prognostic Factors of Primary Chest Wall Chondrosarcomas

Introduction: Primary chest wall tumours are very rare.Chondrosarcoma represents 40% of all chest wall tumours.Wide local excision with tumour free margins has been thegold standard therapy. We evaluated this therapy in relationto various prognostic factors for anticipating the recurrenceof the tumour.Material and methods: 22 cases of Primary chest wallchondrosarcoma was operated upon from 2009 to 2019 withwide local excision with adequate margins. Male constituted77.27% and females 22.73% with the tumour size rangingfrom 5 to 30 cm in size(median 7cm).Results: 19 patients were subjected to lateral chest wallresection. 3 cases underwent partial sternectomies. Resectionwas extended to lungs in 7 cases, diaphragm in 2 cases,vertebral body in 2 cases and clavicle in 2 cases. Reconstructionwas done with polypropylene or titanium mesh and a muscleflap coverage. There was no perioperative mortality. Postoperative complications occurred in 13.6%(n=3). Therewas recurrence in 4 cases within 5 years. 5year disease freesurvival rate was 81.81%.Conclusions: Wide local excision with tumours free marginsstill remains the standard form of therapy. The reconstructiveprocedures have evolved largely to cover the huge defectsfollowing surgery. Post operative adjuvant therapy is guidedby various prognostic factors.

Primary Pleomorphic Adenoma of the External Auditory Canal-A Case Report and Literature Review

Tumours primarily arising from the external auditory canal are very uncommon and 5% of these originate from the glands present in the skin. Primary Pleomorphic adenomas arising from the External Auditory Canal are extremely rare and are difficult to diagnose preoperatively. They have clinically unremarkable presentation, and are treated by wide local excision with adequate normal margins. These tumours are mostly diagnosed postoperatively by histopathological examination and requires a long term follow up. In this case report we describe one such unusual case of primary Pleomorphic adenoma of the external auditory canal along with the literature review.

Surgical treatment of anorectal malignant melanoma from single tertiary center: A retrospective analysis of 91 cases / 中国实用外科杂志

OBJECTIVE:To investigate the surgical treatment of anorectal malignant melanoma(ARMM) and the prognostic factors that affect patients' overall survival(OS).METHODS:Theclinical and pathological data of 91 patients diagnosed as ARMM, who underwent surgery in the Gastrointestinal Cancer Center of Peking University Cancer Hospital from January 2003 to January 2018 were retrospectively analyzed. The effects of different clinicopathological factors on OS of the patients, and difference surgery, abdominal-perineal resection(APR) and wide local excision(WLE) on patients' survival were compared.RESULTS:Of the 91 patients with ARMM, 35(38.5%) were male, 56(61.5%) were female, and the ratio of male to female was 1:1.6. 12 patients(13.2%) underwent wide local excision and 79 patients underwent abdominal-perineal resection(86.8%); there were 19 cases(20.9%) diagnosed with distant metastasis and 72 cases(79.1%)without distant metastasis. The of 1-, 3-, and 5-year survival rates of ARMM patients in this cohort were 74%, 23% and9%; and the median survival of the patients was 18.7 months. The univariate analysis of the clinicopathological features of the patients demonstrated that the preoperative distant metastases, tumor diameters(>2 cm), tumor invasion depth(>2 mm) and lymph node metastasis were the prognostic factors of OS; multivariate analysis showed that preoperative distant metastasis and lymph node metastasis were independent factors affecting OS.The median survival of the patients admitted APR and WLE were both 21 months. There was no significant difference in survival between the WLE and APR group(P=0.94).CONCLUSION:Preoperative distant metastasis and lymph node metastasis are independent prognostic factors for overall survival of ARMM patients.Comparing with WLE, APR could not bring survival benefits.

Selection of anal preservation surgery of low rectal cancer / 中国实用外科杂志

With the promotion of neoadjuvant therapy,the development of minimally invasive techniques and new surgical techniques,the anal preservation rate of low rectalcancer is increasing year by year. To improve postoperative quality of life is an important goal in the treatment of low rectal cancer. At present,the main important low anal preservation surgery is as follows: Intersphincteric resection(ISR),including complete ISR,subtotal ISR,partial ISR and modified partial ISR; Transanal local resection,including transanal endoscopic microsurgery(TEM) and transanal minimally invasive surgery(TAMIS); Anterior perineal planefor ultra-low anterior resection of the rectum(APPEAR),which is performed through a separate perineal incision,israrely used at present; Transanal total mesorectal excision(TaTME) proposed in recent years. Preliminary studies have proven safe and effective for low advanced rectal cancer.TaTME require a learning curve. It is now making expertcon sensus and operation specification,operation training and conducting multi-center prospective study. TaTME isexpected to become the important operation for low rectalcancer.

Retrospective analysis of 19 cases with middle-to-low rectal cancer who underwent local excision following neoadjuvant chemoradiation / 中国实用外科杂志

OBJECTIVE: To investigate the prognosis and quality of life of patients who underwent transanal local excision(LE) following neoadjuvant chemoradiation for mid-low rectal cancer.METHODS: Patients undergo neoadjuvant chemoradiaiton and transanal local excision from March 2011 to June 2016 in Gastrointestinal cancer center,Peking University Cancer Hospital were enrolled in this study. Data of 19 cases were retrospectively collected and analyzed. The primary end points were disease free survival,short-term(1 month)postoperative complications; and secondary endpoints were quality of life and anal function one year after the surgery.RESULTS: Median tumor diameter was 1.0(0.3-3.0)cm. 8(42.1%) cases located in the anterior wall,6 cases(31.6%) in the posterior wall,3 cases(15.8%) in the left wall,and 2 cases(10.5%) in the right wall. The median distance of the tumor from the anal verge was 4.0(1.5-12.0)cm. Postoperative pathology demonstrated that 12 cases(63.2%) ypT0,3 cases(15.8%) ypT1,4 cases(21.1%) ypT2;the median time interval between chemoradiotherapy and LE was 4.3(2.0-36.0)months;The median time of operation was 50(20-137)min,with median blood loss 10(0-50)ml and hospital stay 4(1-5)d. The recurrence rate was 21.1%(1 local recurrence, 2 lung metastasis, 1 pelvic metastasis) with a follow up of 30(2-62) months.TME group had worse quality of life and anal function following TME surgery(P<0.01) while LE group not. LE group has better quality of life(EORTC-C30) and anal function(Wexner) than TME group(P<0.01).CONCLUSION: For mid-low rectal cancer with good response(ycT0-2 N0) following neoadjuvant chemoradiation,local excision might be a safe and feasible treatment option with acceptable anal function anal function.

Wide local excision surgery combined with 5-aminolaevulinic acid photodynamic therapy for Paget's disease of the scrotum in elderly people / 中华老年医学杂志

Objective To investigate the safety and efficacy of wide local excision surgery combined with 5-aminolaevulinic acid(ALA)-photodynamic therapy(PDT)in treating Paget's disease of the scrotum in elderly people.Methods Patients with an average age of 68.4 ± 4.7 years undergoing wide local excision surgery combined with ALA-PDT for Paget's disease of the scrotum from June 2014 to February 2018 were followed up.All patients underwent wide local excision surgical treatment first and were then enrolled in ALA-PDT study after the diagnosis of Paget's disease of the scrotum was confirmed.Four cases were eliminated as a result of two patients refusing photodynamictherapy for various reasons and two patients lost during follow-up after ALA-PDT.A total of 16 patients were included in the study,of whom 6 cases were in Ray stage A1,7 cases in stage A2 and 3 cases in stage B.Patients underwent 3 courses of ALA-PDT after operation.Then the efficacy,shortand medium-term complications were followed up.Results The duration of disease among the 16 patients ranged from 4 to 76 months before diagnosis,with an average of 35.7 months.Surgery was performed immediately after diagnosis.Ten patients underwent resection and suture and 6 patients were treated with skin flap transfers.Of the patients treated with surgery,3 patients received suspicious lymph node dissection and 1 patient underwent reoperation due to skin flap necrosis.Patients were followed up for 3 months to 3 years and 6 months after ALA-PDT.Recurrence and distant metastasis occurred in 2 cases,with 1 case of brain metastasis and 1 case of systemic metastasis,and the overall recurrence rate was 12.5％.During the follow-up,there were no other serious complications except for 1 case(6.3 ％)with lower limb movement disorders.Conclusions Wide local excision surgery combined ALA-PDT has good clinical outcomes,low recurrence rates and few complications for the treatment of Paget's disease of the scrotum in elderly people.

Prognosis analysis of 338 rectal neuroendocrine neoplasms with maximum diameter of 1 cm to 2 cm / 中华消化杂志

Objective To analyze the clinical characteristics and prognostic factors of rectal neuroendocrine neoplasm (r-NEN) with the maximum diameter of 1 cm to 2 cm,and to provide a theoretical evidence for selection of resection method.Methods From 1988 to 2015,the data of patients pathologically diagnosed as r-NEN with the maximum diameter less than 2 cm were selected from American surveillance,epidemiology,and end results (SEER) database with SEER * Stat 8.3.5 software.According to the resection method,the patients were divided into local resection group and radical resection group.T test and chi-square test were performed to compare the clinicopathological features.Kaplan-Meier survival analysis and Cox multivariate analysis were used to analyze the prognostic factors analysis.Results The maximum diameter of tumors of 1 831 patients with r-NEN was less than 1 cm,and that of 338 patients with r-NEN was between 1 cm and 2 cm.There were significant differences between two groups in tumor grade,tumor stage,T stage,lymph node metastasis,distant metastasis and resection method (x2 =7.120,144.728,86.296,133.096,42.842 and 52.048,all P ＜ 0.05).The prognosis of the former was better than that of the latter (x2 =11.590,P =0.001).Among the patients with r-NEN with the maximum diameter of 1 cm to 2 cm,279 (82.5％) patients received local resection and 59 (17.5％) patients underwent radical surgery.Propensity score matching was used to pair the r-NEN patients with the maximum diameter of 1 cm to 2 cm who received different resection methods,and 41 pairs of cases were enrolled.The results of univariate analysis showed that age and tumor grade affected the survival prognosis of patients with r-NEN of the maximum diameter of 1 cm to 2 cm (x2 =6.837 and 10.852,P =0.009 and 0.004).The results of Cox multivariate analysis indicated that age was an independent prognostic factor of patients with r-NEN of the maximum diameter of 1 cm to 2 cm (hazard ratio (HR) =1.110,95％ confidence interval (CI) 1.040 to 1.184,P =0.002).Analysis of subgroups without lymph nodes or distant metastases demonstrated that age (HR =1.101,95％ CI 1.042 to 1.162,P =0.001) and resection method (HR =3.128,95％ CI 1.003 to 9.754,P =0.049) were the independent factors.Conclusions Age is an independent factor of patients with r-NEN of the maximum diameter of 1 cm to 2 cm.Among the patients without lymph nodes or distant metastasis the younger cases and those with local resection have better prognosis.

New treatment strategy after neoadjuvant chemoradiotherapy in low rectal cancer / 国际肿瘤学杂志

Rectal cancer is one of the most common malignant tumor in our country,among them with highest incidence of low rectal cancer.With the further study on the biological behavior of rectal cancer and the development of diagnostic and therapeutic techniques,gastrointestinal oncologists have proposed a new treatment strategy-local resection and wait-and-see.This strategy can better preserve anal function and improve the quality of life of patients without losing the good tumor control of the traditional standard treatment model.

The prognostic and influence factors analysis of transanal local resection for stage T1rectal cancer with the distance from anal margin ≤8 cm / 实用肿瘤学杂志

Objective The objective of this was to investipate study the prognostic and influence factors in patients with transanal local resection for stage T1rectal cancer with the distance from anal margin≤8 cm. Methods A fotal of patients with 180 rectal cancer of stage T1with the distance from anal margin≤8 cm from March 2010 to March 2014 were Retrospective analysed,and there were 90 cases received the local resection of rectal cancer as the observation group and 90 patients with the T1stage who under-went radical resection of rectal cancer as the control group. The postoperative recovery effects were compared between the abservation and control groups. The rates of 3-year overall survival and progression-free survival were recorded. The prognostic influence factors of rectal cancer patients at the stage T1with the distance from the anal margin ≤8 cm after transanal local resection were analyzed. Results The operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative hospitalization stay and postoper-ative complications were significantly lower in the observation group than those in the control group(P<0. 05). There were no signifi-cant difference in overall survival and progression free survival between the two groups(χ2= 0. 896,0. 358;P=0. 344,0. 550). Logis-tic multivariate analysis showed that age,degree of differentiation and cutting edge properties were independent risk factors for the prognosis of patients with rectal cancer who were≤8 cm from the anal margin(P<0. 05). Conclusion Transanal local resection for patients with rectal cancer T1stage from distance to anal margin can achieve similar prognostic benefits as radical surgery,and it can promote early recovery after surgery. Age,tumor differentiation and marginal properties are independent factors,which affected the prognosis of the patients undergoing surgery.

Primary osteosarcoma of the breast: a case report

Primary osteosarcomas of the breast are extremely uncommon. Here we describe a case of a 77-year-old woman who presented with a hard mass on her right breast. Mammography and breast ultrasound demonstrated a round-shaped calcified mass on the right breast but the features were not definitely diagnostic. For diagnostic purposes, an excisional biopsy was performed and the mass proved to be a primary osteosarcoma of the breast by pathologic findings. PET-CT and whole body bone scan showed neither evidence of metastasis nor underlying bone lesions. Wide excision without axillary lymph node dissection was performed after diagnosis. Further treatment such as adjuvant chemotherapy or radiation therapy was not performed. We discuss proper treatment of this rare type of breast cancer.

Controversial issues in radiotherapy for rectal cancer: a systematic review

The role of radiotherapy (RT) as an adjuvant to surgical options in the treatment of locally advanced rectal cancer has been established as it reduces local recurrence when combined with surgical resection and enhances survival when used in multidisciplinary treatment. However, many issues need to be addressed; some of these can render RT unnecessary, whereas others can reveal a new role of RT in rectal cancer. This review will discuss not only the basic role of RT but also the associated but controversial issues in detail in an attempt to find answers and determine future directions for the next decade.

Outcomes of different surgical approaches and prognostic factors of T1 rectal cancer with distance from anal verge ≤8.0 cm / 中华消化外科杂志

Objective To investigate the clinical outcomes of transanal local excision (LE) and transabdominal radical surgery (RS) for T1 rectal cancer with distance from anal verge (DAV) ≤ 8.0 cm,and analyze the prognostic factors after non-palliative resection of T1 rectal cancer with DAV ≤8.0 cm.Methods Theretrospective cohort study was conducted.The clinicopathological data of 82 T1 rectal cancer patients with DAV ≤8.0 cm who were admitted to the Fujian Medical University Union Hospital between December 2000 and December 2014 were collected.Among 82 patients,42 undergoing transanal LE and 40 undergoing transabdominal RS were allocated into the LS and RS groups,respectively.Forty-two patients in the LE group received transabdominal RS or postoperative adjuvant radiochemotherapy if results of postoperative pathological examination showed high risk.Observation indicators:(1) comparisons of surgical and postoperative situations between the 2 groups;(2) followup situations;(3) prognostic factors analysis after non-palliative resection of T1 rectal cancer with DAV ≤ 8.0 cm.Follow-up using outpatient examination and telephone interview was performed to detect the defecation and sexual functions,survival and tumor recurrence up to January 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with an independent sample t test.Comparisons of count data were analyzed using the chi-square test or Fisher exact probability.The Kaplan Meier method was used for calculating overall survival rate and tumor-free rate,and survival was analyzed using the Logrank test.Multivariate analysis was done using the COX regression model.Results (1) Comparisons of surgical and postoperative situations between the 2 groups:all the 82 patients underwent successful surgery.Of 42 patients in the LE group,28 underwent single transanal LE,2 underwent additional transabdominal RS within 1 month postoperatively,6 underwent postoperative adjuvant radiochemotherapy,5 underwent postoperative adjuvant radiotherapy and 1 underwent postoperative adjuvant chemotherapy (didn't complete course due to poor tolerance).Forty patients in the RS group underwent transabdominal anterior resection of rectum or combined with abdominal perineal resection for rectal cancer.DAV,operation time,volume of intraoperative blood loss,time of postoperative gastrointestinal function recovery,cases with pulmonary infection and duration of postoperative hospital stay were (4.9±1.3)cm,(65±33) minutes,(11±7)mL,(1.2±0.4) days,0,(2.2±0.9)days in the LEgroupand (6.7±1.9)cm,(256±35)minutes,(65±47) mL,(2.4±0.8)days,6,(6.9±1.1) days in the RS group,respectively,with statistically significant differences (t =4.882,12.448,3.553,4.025,x2 =6.797,t =10.367,P＜0.05).Cases with intraperitoneal infection,wound infection,urinary tract infection,inflammatory intestinal obstruction,anastomotic fistula,chyle leakage,rectovaginal fistula and positive surgical margin were 0,0,0,0,0,0,0,1 in the LE group and 1,0,0,1,0,2,l,0 in the RS group,respectively,with no statistically significant differences between the 2 groups (x2 =1.063,1.063,2.153,1.063,P＞0.05).All patients with complications were cured by conservative treatment.(2) Follow-up situations:of 82 patients,67were followed up for defecation function (37 in the LE group and 30 in the RS group),40 were followed up for sexual function (25 in the LE group and 15 in the RS group),76 were followed up for survival.Follow-up time was 1-145 months,with a median time of 31 months.Cases with fecal incontinence and sexual dysfunction were respectively 0,0 in the LE group and 4,3 in the RS group,showing statistically significant differences (x2 =5.247,5.405,P＜0.05).Cases with 5-year local recurrence,5-year overall survival rate and 5-year tumor-free survival rate were respectively 1,94.1％,91.0％ in the LE group and 0,87.6％,87.6％ in the RS group,showing no statistically significant differences (x2 =0.833,2.313,0.849,P＞0.05).(3) Prognostic factors analysis after non-palliative resection of T1 rectal cancer with DAV ≤ 8.0 cm:results of multivariate analysis showed that age was an independent factor affecting prognosis of T1 rectal cancer patients with DAV ≤8.0 cm after non-palliative resection (RR =1.254,95％ confidence interval:1.055-1.491,P＜0.05).Conclusions Transanal LE in treatment of T1 rectal cancer patients with DAV ≤ 8.0 cm is consistent with RS in local control and long term prognosis,and the protection of defecation and sexual functions in LE is superior to that in RS.Age is an independent factor affecting prognosis of T1 rectal cancer patients with DAV ≤ 8.0 cm after non-palliative resection.

Cystosarcoma phyllodes: Pathological enigma: A retrospective review of 162 cases.

PURPOSE: Phyllodes tumor (PT) is a rare fibroepithelial neoplasm comprising <1% of all breast tumors. Clinical spectrum ranges from benign (B), borderline (BL), and locally recurrent to malignant (M) and metastatic type. The aim of our study was to analyze the clinicopathological factors, compare treatment options, and evaluate outcome in patients with PT. METHODS: We retrospectively reviewed 162 women with PT. The surgical intervention varied from simple excision (lumpectomy)/wide local excision (WLE) in benign cases to simple/modified radical or radical mastectomy (SM/MRM/ RM) in malignant and recurrent tumors. RESULTS: Out of 162 patients, B, BL, and M were 95 (58.64%), 29 (18%), and 38 (23.45%), respectively. Mean age, duration of lump, and size were 38 ± 8 years, 28 ± 10 months, and 12 ± 5 cm, respectively. Recurrence rate with B, BL, and M was 15.78%, 41.37%, and 55.26%, respectively (P = 0.00001). As compared to WLE (22%), SM (23.8%), and MRM/RM (14.2%), recurrence was higher with lumpectomy (48.9%) (P = 0.004). Positive correlation was found between recurrence rate with the size of tumor (P = 0.008) and also number of recurrence with holoprosencephaly (P = 0.047). There was no association between the number of recurrences and size of tumor (P = 0.63). Malignant PT was seen in 38 (24%) and distant metastasis was seen in 7 (18%). Mean duration of follow‑up was 42 months. CONCLUSION: WLE with negative margins should be the initial surgery for PT. The role of adjuvant radiotherapy and chemotherapy is uncertain. PT is pathological enigma. Till date, no factors can accurately predict the recurrence and outcome. PT is known for unpredictable behavior and high recurrence rates, hence long‑term follow‑up is advised.

Cost comparison between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors

PURPOSE: To compare medical costs of endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) for the treatment of rectal tumors. METHODS: The records of 80 patients who underwent ESD and 32 who underwent TEM for the treatment of rectal tumors were collected. Factors compared in the two groups included patient age, sex and clinical characteristics, as well as hospital stay, procedure time, instrument use, medications, postoperative complications, and imaging and laboratory findings. Costs were analyzed based on medical insurance fees, as set publicly by the Ministry of Health & Welfare, Korea. Medical costs were also divided into patient copayments and National Health Insurance (NHI) Corporation charges. RESULTS: Patient characteristics, including age, sex, and comorbidities, were similar in the two groups, as were procedure time, histologic diagnosis, tumor size and distance from the anal verge, hospital stay, and complication rates. Median total hospital costs were significantly lower in the ESD than in the TEM group (1,214 United State dollars [USD] vs. 1,686 USD, P < 0.001). The costs for consumables, drugs and laboratory as well as operation fee were also significantly lower in the ESD than in the TEM group. However, patient copayments in the ESD group were significantly higher than in the TEM group (928 USD vs. 496 USD, P < 0.001), because ESD procedure for rectal tumors is not yet covered by the Korean NHI. CONCLUSION: Overall direct medical costs were significantly lower for ESD than for TEM in the treatment of rectal tumors.

Primary Anorectal Malignant Melanoma Treated With Endoscopic Mucosal Resection

Anorectal melanoma is a rare neoplasm that accounts for less than 1-4% of anorectal malignant tumors. The main therapeutic modality for anorectal melanoma is surgical treatment, with abdominoperineal resection or wide local excision being the most common approaches. A 77-year-old male with a history of cerebral infarction and hypertension presented with anal bleeding. Here, we report a case of anorectal melanoma treated by endoscopic mucosal resection with adjuvant interferon therapy rather than surgical resection. The patient has been disease-free for 5 years after endoscopic treatment.