Sarcomatoid intrahepatic cholangiocarcinoma with good patient prognosis after treatment with Huaier granules following hepatectomy: A case report.

BACKGROUND: Sarcomatoid intrahepatic cholangiocarcinoma (SICC) is an extremely rare and highly invasive malignant tumor of the liver. The precise pathologic mechanism of SICC has not been clearly identified, and the prognosis is very poor. The effectiveness of the treatment strategy of radical hepatectomy combined with Huaier granules has not yet been reported. CASE SUMMARY: The patient was a 69-year-old male who presented with intermittent right upper abdominal pain for one month and 4-pound weight loss before admission. Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography showed multiple stones in the bile ducts accompanied by dilatation of the intrahepatic and extrahepatic bile ducts. The preoperative diagnoses were right intrahepatic bile duct stones and extrahepatic bile duct stones; thus, surgical resection was performed. Choledochoscopy showed that the bile duct wall of the right anterior lobe was thickened, and a mass was visible in the duct. Then, a biopsy was performed, and rapid frozen-section biopsy analysis indicated that the tumor was malignant. The final diagnosis was SICC (T1aN0M0). Huaier granules were taken by the patient as anticancer therapy after surgery. The patient attended follow-up for 72 mo with no tumor recurrence or metastasis. CONCLUSION: Sarcomatous intrahepatic cholangiocarcinoma is an extremely rare, aggressive malignancy, and the diagnostic gold standard is pathological diagnosis. We reported the first case of successful treatment with Huaier granules as anticancer therapy after surgery, which indicated that Huaier granules are safe and effective. Further studies are needed to study the anticancer molecular mechanisms of Huaier granules in sarcomatous intrahepatic cholangiocarcinoma.

Percutaneous Endoscopic Removal of Cervical Foraminal Schwannoma via Interlaminar Approach: A Case Report.

BACKGROUND AND IMPORTANCE: Cervical foraminal schwannomas commonly originate from spinal nerves that pass through the intervertebral foramen of the cervical vertebrae. Because of the proximity of this type of tumor to the vertebral artery and spinal nerves, surgical management remains a major challenge. Conventional open spine surgery usually requires the removal of the articular process and is supplemented by a simultaneous posterolateral spine fusion surgery. To decrease the associated risks of surgical complications by further reducing invasiveness, percutaneous spinal endoscopy may be used for resection of foraminal spinal neoplasm. CLINICAL PRESENTATION: A 52-yr-old female who presented with neck pains with duration of 1 yr was admitted to our hospital. Physical examination revealed moderate rigidity in the neck and grade 5 muscle strength in both upper and lower limbs. Preoperative magnetic resonance imaging (MRI) scans demonstrated a left-sided lesion at the C3-C4 intervertebral foraminal area. Under C-arm fluoroscopy navigation and neuromonitoring, the endoscope was properly positioned on the same side of the tumor, and a small part of the left C3 inferior and C4 superior lamina were first removed by an endoscopic drill to enlarge the interlaminar space. Next, through an endoscopic working canal, the left intervertebral ligamentum flavum was removed to fully expose the tumor. The tumor mass was finally resected in a piecemeal approach. Postoperative MRI confirmed complete tumor resection. CONCLUSION: This is the first case report of a total removal of a cervical foraminal schwannoma with a percutaneous spinal endoscopic procedure.

Full-Endoscopic Transforaminal Approach for Removal of a Spontaneous Spinal Epidural Hematoma.

BACKGROUND: The incidence of spinal epidural hematoma (SEH) is estimated to be 1 per 1,000,000 patients per year; SEH can be classified as idiopathic, spontaneous, and secondary. The cause of spontaneous SEH is uncertain but it may be associated with minor trauma. SEH can compress surrounding structures, shown by clinical symptoms and signs that affect the spinal cord or nerve roots. Surgical treatment may be considered if medical treatment fails. CASE DESCRIPTION: A 26-year-old man presented with lower back pain and significant radicular symptoms on the left side for a week. He denied previous lumbar trauma or the use of anticoagulation drugs. We used the full-endoscopic transforaminal approach (extraforaminal technique) to remove the SEH under local anesthesia. The patient was discharged home 2 days after surgery and the radicular pain disappeared completely. Three months later, follow-up magnetic resonance imaging showed that the dark-brown lesion had been totally removed. CONCLUSIONS: Spontaneous SEHs are uncommon. Although lumbar laminectomy is the mainstream treatment in those with neurologic deficits caused by epidural hematomas, the percutaneous full-endoscopic transforaminal approach may be an option for certain SEHs.

Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis.

BACKGROUND: The objective of this study was to evaluate the feasibility, safety, and potential benefits of laparoscopic gastrectomy (LG) comparing with open gastrectomy (OG) in elderly population. METHODS: Studies comparing LG with OG for elderly population with gastric cancer, published between January 1994 and July 2015, were identified in the PubMed, Embase, and ISI Web of Science databases. Operative outcomes (intraoperative blood loss, operative time, and the number of lymph nodes harvested) and postoperative outcomes (time to first ambulation, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity) were included and analyzed. The Newcastle-Ottawa Scale was used to assess the quality of the pooled study. A funnel plot was used to evaluate the publication bias. RESULTS: Seven studies totaling 845 patients were included in the meta-analysis. LG in comparison to OG showed less intraoperative blood loss (weighted mean difference (WMD) -127.47; 95% confidence interval (CI) -202.79 to -52.16; P < 0.01), earlier time to first ambulation (WMD -2.07; 95% CI -2.84 to -1.30; P < 0.01), first flatus (WMD -1.04; 95% CI -1.45 to -0.63; P < 0.01), and oral intake (WMD -0.94; 95% CI -1.11 to -0.77; P < 0.01), postoperative hospital stay (WMD -5.26; 95% CI -7.58 to -2.93; P < 0.01), lower overall postoperative complication rate (odd ratio (OR) 0.39; 95% CI 0.28 to 0.55; P < 0.01), less surgical complications (OR 0.47; 95% CI 0.32 to 0.69; P < 0.01), medical complication (OR 0.35; 95% CI 0.22 to 0.56; P < 0.01), incisional complication (OR 0.40; 95% CI 0.19 to 0.85; P = 0.02), and pulmonary infection (OR 0.49; 95% CI 0.26 to 0.93; P = 0.03). No significant differences were observed between LG and OG for the number of harvested lymph nodes. However, LG had longer operative times (WMD 15.73; 95% CI 6.23 to 25.23; P < 0.01). CONCLUSIONS: LG is a feasible and safe approach for elderly patients with gastric cancer. Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.