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Background: Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect.Methods: The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed.Results: The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates).Conclusion: The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Although functional end-to-end anastomosis (FEEA) using a stapler in the colorectal field has been recognised worldwide, the technique varies by surgeon, and the safety of anastomosis using different techniques is unknown. Methods: This multicentre prospective observational cohort study was conducted by the KYCC Study Group in Yokohama, Japan, and included patients who underwent colonic resection at seven centres between April 2020 and March 2022. This study compared the incidence of surgery-related abdominal complications (SAC: anastomotic leakage [AL], anastomotic bleeding, intra-abdominal abscess, enteritis, ileus, surgical site infection, and other abdominal complications) between two different methods of FEEA (one-step [OS] method: simultaneous anastomosis and bowel resection; two-step [TS] method: anastomosis after bowel resection). Complications of Clavien–Dindo classification grade 2 or higher were assessed. Results: Among 293 eligible cases, the OS and TS methods were used in 194 (66.2%) and 99 (33.8%) patients, respectively. The baseline characteristics were similar between the groups. The OS method used fewer staplers (three vs. four staplers, p < 0.00001). There were no significant differences in SAC rate between the OS (19.1%) and the TS (16.2%) groups (p = 0.44). The OS group had four cases (2.1%) of AL (two patients; grade 3, two patients; grade 2) while the TS group had one case (1.0%) of grade 2 AL (p = 0.67). Multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.95; p < 0.00001), an open surgical approach (OR 2.36; p = 0.03), and longer operative duration (OR,2.79; p = 0.002) were independent predictors of complications, whereas the OS method was not an independent predictor (OR 1.17; p = 0.66). Conclusions: The OS and the TS technique for stapled colonic anastomosis in a FEEA had a similar postoperative complication rate. Trial registration number: UMIN000039902 (registration date 23 March 2020). [ABSTRACT FROM AUTHOR]

The article presents the case study of a 80-year-old woman who suffered a right groin pain. She had developed an abdominal pain that was associated with nausea and vomiting. An examination revealed the has abdominal tenderness and abdominal bowel pain. Furthermore, a computed tomography scan showed small protruding through the right obturator foramen. In addition, a surgery regime is suggested.

Purpose: The aim of this study is to reveal the vascular branching variation in SFC (splenic flexure cancer) patients using the preoperative three-dimensional computed tomography angiography with colonography (3D-CTAC). Methods: We retrospectively analyzed patients with SFC who underwent preoperative 3D-CTAC between January 2014 and December 2019. Results: Among 1256 colorectal cancer (CRC) patients, 96 (7.6%) manifested SFC. The arterial branching from the superior mesenteric artery (SMA) was classified into five patterns, as follows: (type 1A) the left branch of middle colic artery (LMCA) diverged from middle colic artery (MCA) (N = 47, 49.0%); (2A) the LMCA diverged from the MCA and the accessory middle colic artery (AMCA) (N = 26, 27.1%); (3A) the LMCA independently diverged from the SMA (N = 16, 16.7%); (4A) the LMCA independently diverged from the SMA and AMCA (N = 3, 3.1%); (5A) only the AMCA and the LMCA was absent (N = 4, 4.1%). Venous drainage was classified into four patterns, as follows: (type 1V) the SFV flows into the inferior mesenteric vein (IMV) then back to the splenic vein (N = 50, 52.1%); (2V) the SFV flows into the IMV then back to the superior mesenteric vein (SMV) (N = 19, 19.8%); (type 3V) the SFV independently flows into the splenic vein (N = 3, 3.1%); (type 4V) the SFV is absent (N = 24, 25.0%). Conclusion: 3D-CTAC could reveal accurate preoperative tumor localization and vascular branching. These classifications should be helpful in performing accurate complete mesocolic excision and central vessel ligation for SFC. [ABSTRACT FROM AUTHOR]

Background: Complete mesocolic excision with central vessel ligation may be important for accurate staging and improving the prognosis of right-sided colon cancer. Although the procedure is often performed laparoscopically, approaching the middle colic artery (MCA) is technically demanding, especially when complete ligation of arteries at their roots is desired. We standardized our laparoscopic approach by establishing the dissection boundary along the superior mesenteric artery to achieve D3 lymphadenectomy in the region of the MCA. The aim of the present study was to evaluate, on the basis of perioperative and short-term oncologic outcomes, the feasibility and safety of our technique Methods: We conducted a retrospective study on consecutive patients with cancer located at the ascending colon and transverse colon who had laparoscopic right hemicolectomy requiring ligation of the MCA. Results: There were 41 patients (22 males, median age 71 years [range 49–86] years). The median operation time was 285 min, and blood loss volume was 40 mL. Conversion to open surgery was required in 1 case. Complications that were Clavien–Dindo grade III or above occurred in 3 patients (7.3%). There was no anastomotic leakage. The median number of lymph nodes harvested was 46. Conclusions: Our technique was shown to be a safe, feasible, and useful strategy for performance of right hemicolectomy requiring ligation of the MCA in cases of colon cancer. The technique facilitates maximal lymph node dissection. Having obtained favorable outcomes, we look forward to investigation into long-term outcomes. [ABSTRACT FROM AUTHOR]

The 3rd arm gently grasps the mesentery upward, and 2nd arm pulls the retroperitoneum downward for countertraction; the dissection between the retroperitoneum and left-sided colonic mesentery, from medially to laterally, is performed. Counter traction, formed by the 2nd arm grasping the anterior wall of the rectum and the 3rd arm grasping the peritoneum of the pelvic wall, will enable linear dissection line visualization (Fig. Hence, sufficient Z axis traction should be confirmed first; then, the medial traction of the rectum by the 2nd arm and the lateral traction by the 3rd arm will allow visualization of the border between the mesorectum and the NVB (Fig. Our procedure allows dissection of the anterior and posterior antecedent to the lateral demanding field, which visualizes the sandwiched lateral dissection line. [Extracted from the article]

The usefulness of re-sentinel node biopsy (re-SNB) is unclear in the management of patients with ipsilateral recurrent breast cancer. We retrospectively reviewed 52 patients with locally recurrent breast cancer who underwent re-SNB from July 2012 to March 2019. Both radioactive colloid and indocyanine green were used in all cases. Forty-four patients were after SNB and 8 were after axillary lymph node dissection(ALND). SLNs were successfully visualized by lymphoscintigraphy in 94.2% (49/52) of cases (95.4% post-SNB vs. 87.5% post-ALND, Fisher's exact test, p = 0.401). Among post-SNB patients with successful mapping, 50% had SLNs only in ipsilateral axilla(I) and 50% had at least one SLN in other regions(contralateral axilla [C] and/or parasternal region [P])with or without SLN in (I), compared to 28.6% and 71.4% in post-ALND cases respectively(p = 0.424). Among post-SNB cases with prior breast irradiation (n = 37), 44.4% had SLN only in (I) and 55.6% had at least one SLN in other regions, compared to 83.3% and 16.7% in cases without prior irradiation (n = 7) (p = 0.184), respectively. While these differences were not significant, a lower rate of visualization and higher frequency of aberrant lymphatic flow in post-ALND than those in post-SNB was noted, and prior irradiation might affect lymphatic flow. We tried re-SNB for 47 cases and SLNs were successfully removed in 45 (95.7%) patients (92.8% in post-SNB, 100% in post-ALND). Re-SNB for (I) was performed for all cases with hot spots in (I) and one case without hot spot. Re-SNB for (C) or (P) were decided based on physician's judgment. The SLN identification rates by site were 92.1% (35/38) for (I), 90.0% (9/10) for (C), and 100% (3/3) for (P). Sentinel node metastasis was found in three cases, all of which were in (I). ALND was performed in one case with macrometastasis but was omitted in two cases with micrometastases. The median follow-up duration after re-SNB was 22 months and no recurrence was observed. Sentinel node identification was possible with high detection rates among patients with recurrent breast cancer after prior breast-conserving and axillary surgery. The authors. Has not received any funding. T. Yamanaka: Honoraria (self): Chugai; Honoraria (self): Eisai; Honoraria (self): Novartis Pharma; Honoraria (self): Taiho; Honoraria (self): Phizer Japan. T. Yamashita: Honoraria (self), Research grant / Funding (institution): Chugai; Honoraria (self): Eisai; Honoraria (self): Novartis Pharma; Honoraria (self): Taiho; Honoraria (self), Research grant / Funding (institution): Nippon Kayaku; Honoraria (self): AstraZeneca; Honoraria (self), Research grant / Funding (institution): Kyowa kirin; Honoraria (self): Phizer Japan; Honoraria (self): Takeda. N. Suganuma: Honoraria (self): Eisai; Honoraria (self): Novartis Pharma; Honoraria (self): Taiho; Honoraria (self): Kyowa kirin; Honoraria (self): Phizer Japan. All other authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background: Invasive micropapillary carcinoma(IMPC) is a rare variant of invasive breast cancer that is associated with a high incidence of lymph node(LN) metastasis. But, the meaning of focal micropapillary component has not been fully elucidated. Methods: We retrospectively reviewed 88 invasive breast carcinoma cases with IMPC and focal micropapillary component. Results: Sixty-four cases had micropapillary component only in operative specimens, 18 cases had only in core-needle specimens, and 6 cases had in both. Sixteen were diagnosed as IMPC, and 72 cases had focal micropapillary component with other histological type of invasive breast carcinoma; 65 cases with invasive ductal carcinoma, 6 cases with mucinous carcinoma and one with metaplastic carcinoma. There was one male patient. Mean age was 56.5 years old. Median tumor size was 2.5 cm. Forty two (47.7%) cases were nuclear grade (NG)1, 16 (18.2%) were NG2 and 30 (34.1%) were NG3. Seventy eight cases (90%) were ERand/orPgR positive and 18.5% were HER2 positive. Six cases had distant metastasis at initial diagnosis. LN metastases were observed in 63.6% of all cases, and this high rate of LN metastasis could be seen even in small tumor group; 45.5% in cases with tumor equal or less than 2 cm. In the group of IMPC, 40.0% had LN metastasis, and 56.9% in cases with focal micropapillary component. There was no significant difference between IMPC and focal micropapillary component by univariate analysis(p = 0.055). Multivariate analysis of all cases showed that tumor size(>2cm)(p = 0.047), NG(1 vs 2&3, p = 0.017), and lymphatic invasion(p = 0.001) were significantly associated with LN metastasis. No significant difference between IMPC and focal micropapillary component was showed by multivariate analysis also (p = 0.60). Hormone receptor status or HER2 status were also not correlated(p = 0.92, p = 0.27 respectively). Among female patients without neoadjuvant chemotherapy, sentinel lymph node biopsy(SLNB) were underwent in 38 cases, and 16 cases (42.1%) had positive sentinel lymph node(SLN). Fourteen patients underwent additional axillary dissection and 7 cases (50%) had non-SLN metastases. Among patients with SLNB, 12 patients had micropapillary component in needle biopsy specimens, and 6 (50%) cases had positive SLN. Conclusion: Our data showed very high rate of LN metastasis in patients with micropapillary component, and this tendency still exists in cases with only focal micropapillary pattern. High positivity of SLNB was observed in these groups, and our data suggests that the findings of micropapillary component in CNB specimen could be used as a predictor of SLN metastasis. [ABSTRACT FROM AUTHOR]