Laparoscopic and endoscopic cooperative surgery for full-thickness resection and sentinel node dissection for early gastric cancer.

The endoscopic submucosal dissection (ESD) technique has become the gold standard for submucosal tumors that have negligible risk of lymph node metastasis (LNM), due to its minimal invasiveness and ability to improve quality of life. However, this technique is limited in stage T1 cancers that have a low risk of LNM. Endoscopic full thickness resection can be achieved with laparoscopic endoscopic cooperative surgery (LECS), which combines laparoscopic gastric wall resection and ESD. In LECS, the surgical margins from the tumor are clearly achieved while performing organ-preserving surgery. To overcome the limitation of classical LECS, namely the opening of the gastric wall during the procedure, which increases the risk of peritoneal tumor seeding, non-exposed endoscopic wall-inversion surgery was developed. With this full-thickness resection technique, contact between the intra-abdominal space and the intragastric space was eliminated.

Intravascular leiomyomatosis with intracardiac extension: a toraco-abdominal approach.

Intravenous leiomyomatosis is a rare nonmalignant tumor, which originates from the uterine smooth muscle cells and is usually confined to the pelvic venous system. Sometimes it can extend from the pelvis through the veins into the right side of the heart; this condition is named intracardiac leiomyomatosis (ICLM). To date few cases of these conditions have been described, the treatment is surgical, often challenging and usually multidisciplinary. In this paper are described the clinical presentation, the full radiologic study and surgical treatment of a case of ICLM that authors treated at their institution with thoraco-abdominal approach. Surgical removal of the ICLM is strongly recommended, because no recurrence has been reported, in our case at 7 years we did not observe recurrence of the disease.