scholarly journals Endoscopic Mucosal Resection Performed Underwater for Nonampullary Duodenal Epithelial Tumor: Evaluation of Feasibility and Safety

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Goro Shibukawa ◽  
Atsushi Irisawa ◽  
Ai Sato ◽  
Yoko Abe ◽  
Akane Yamabe ◽  
...  
Keyword(s):  
Treatment Method ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
En Bloc ◽  
Serious Adverse Events ◽  
Epithelial Tumor ◽  
Gastrointestinal Lesions ◽  
Secondary Objective ◽  
Nodular Lesions

Objectives. Recently, opportunities to encounter superficial nonampullary duodenal epithelial tumor (SNADET) have increased. EMR and ESD are performed to treat SNADET. However, the rate of perforation is higher than that of other gastrointestinal lesions, regardless of which method is used. Underwater EMR (UW-EMR) is immersion treatment of SNADET, which has low risk of perforation and can remove lesions safely and completely. In the present study, we retrospectively investigated patients in whom UW-EMR was performed to evaluate the feasibility and safety of UW-EMR for the treatment of SNADET. Methods. The primary endpoint was to evaluate the feasibility of UW-EMR for the treatment of SNADET, and secondary objective was to determine the operation’s safety. Results. There were 14 participants, with a total of 16 lesions, who underwent UW-EMR between August 2015 and December 2017. Histological heteromorphism revealed that seven patients had low-grade adenoma, seven had high-grade adenoma, and two had adenocarcinoma. En bloc resection was performed in 14 lesions. In two patients, nodular lesions were observed in the scar and biopsy confirmed recurrences. There were no serious adverse events including bleeding or perforation. Conclusions. UW-EMR may be a safe and effective treatment method for SNADET, if its therapeutic indication is adequately considered.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

scholarly journals Leptomeningeal dissemination of a low-grade lumbar paraganglioma: case report

2017 ◽  
Vol 26 (4) ◽  
pp. 501-506 ◽  
Author(s):  
Nick Thomson ◽  
Karel Pacak ◽  
Meic H. Schmidt ◽  
Cheryl A. Palmer ◽  
Karen L. Salzman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ct Scanning ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Chemotherapeutic Agents ◽  
Low Grade ◽  
Leptomeningeal Dissemination ◽  
Mri Findings ◽  
En Bloc ◽  
Pet Scanning

Leptomeningeal dissemination of paraganglioma is rare, with only 2 prior cases in the literature. The authors present the case of a metastatic low-grade lumbar paraganglioma via leptomeningeal dissemination. This report emphasizes the utility of 3,4-dihydroxy-6-18F-fluoro-l-phenylalanine (18F-FDOPA) PET scanning for diagnosis, as well as the combination of radiation therapy and alkylating chemotherapeutic agents for the treatment of this rare phenomenon. The patient was a 61-year-old woman who presented with low-back pain and was found to have an isolated L-3 intrathecal tumor on MRI. Sixteen months after gross-total en bloc resection of the paraganglioma, the patient again became symptomatic with new neurological symptoms. MRI findings revealed enhancing leptomeningeal nodules throughout the spine. 18F-FDOPA PET/CT scanning was used to confirm the diagnosis of disseminated paraganglioma. Intrathecal thiotepa, radiation therapy, and systemic therapy with capecitabine and temozolomide have been used sequentially over a 2-year period, with each able to stabilize tumor growth for several months. The authors also summarize the 2 other reports of leptomeningeal dissemination of paragangliomas in the literature and compare the course and management of the 3 cases.

Endoscopic resection of low grade, subglottic chondrosarcoma

2009 ◽  
Vol 123 (12) ◽  
pp. 1364-1366 ◽  
Author(s):  
Y Oestreicher-Kedem ◽  
T G Dray ◽  
E J Damrose
Keyword(s):  
Endoscopic Resection ◽  
Cricoid Cartilage ◽  
Voice Quality ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
Retrospective Case ◽  
En Bloc ◽  
Extensive Resection ◽  
Airway Patency

AbstractIntroduction:This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.Method:Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.Results:Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.Summary:Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

scholarly journals Endoscopic submucosal dissection and tunneling procedures using a novel all-in-one bipolar device

2020 ◽  
Vol 08 (10) ◽  
pp. E1302-E1307
Author(s):  
Zaheer Nabi ◽  
Radhika Chavan ◽  
Mohan Ramchandani ◽  
Zacharias Tsiamoulos ◽  
Jahanqeer Basha ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Rectal Polyp ◽  
En Bloc ◽  
Epithelial Tumor ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Dissection ◽  
Bipolar Device

Abstract Background and study aims Recent innovations in devices and techniques have revolutionized the field of endoscopic resection procedures. In this study, we evaluated the safety and feasibility of endoscopic submucosal dissection and tunneling procedures with a novel, multipurpose bipolar device. Patients and methods Data from consecutive patients who underwent per-oral endoscopic myotomy (POEM), submucosal tunneling endoscopic resection (STER), and endoscopic submucosal dissection (ESD) using a novel bipolar device (December 2019 to February 2020) were analyzed retrospectively. Procedure duration, technical success, and adverse events (AEs) were recorded. Results A total of 10 procedures were performed using the novel bipolar device during the study period. The procedures included POEM (n = 7), STER for esophageal sub-epithelial tumor (n = 1), ESD for rectal polyp (n = 1), and gastric neuroendocrine tumor (n = 1). POEM was successfully completed in all patients. In patients who underwent STER and ESD, en-bloc resection was achieved in all. Mean procedure time for submucosal tunneling procedures (POEM and STER) was 59.12 ± 31.12 minutes. The procedures were completed without the requirement for exchange of accessories in eight cases (80 %). There were no major AEs. Mild and moderate AEs occurred during POEM and included capno-peritoneum (n = 1), retroperitoneal CO2 (n = 1), and empyema (n = 1). Conclusion ESD and tunneling procedures can be safely performed without the need for exchange of accessories using a novel bipolar device. Randomized comparison with conventional knives isrequired to confirm the utility of this device.

scholarly journals An IDH1-mutated primary gliosarcoma: case report

2017 ◽  
Vol 126 (2) ◽  
pp. 476-480 ◽  
Author(s):  
Jason K. Hsieh ◽  
Christopher S. Hong ◽  
Sunil Manjila ◽  
Mark L. Cohen ◽  
Simon Lo ◽  
...  
Keyword(s):  
Isocitrate Dehydrogenase ◽  
Brain Mri ◽  
High Grade Glioma ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
Isocitrate Dehydrogenase 1 ◽  
En Bloc ◽  
History Of ◽  
Isocitrate Dehydrogenase Mutation

The authors present the case of a primary gliosarcoma with an isocitrate dehydrogenase-1 (IDH1) mutation. A 75-year-old man presented with a 3-day history of multiple focal seizures and was found on MRI to have a 2.2-cm left parietal enhancing mass lesion. Brain MRI for tremor performed 8 years prior to this presentation was normal. En bloc resection revealed a high-grade glioma with sarcomatous components that was immunoreactive for the R132H variant of IDH1 by antibody. Gliosarcoma is a rare variant of glioblastoma that arises most frequently as a primary tumor, and has equal or worse survival and an increased propensity for extracranial metastases compared with other Grade 4 gliomas. In contrast, isocitrate dehydrogenase-1 and -2 mutations are associated with low-grade gliomas with increased survival and less commonly with glioblastoma. To the authors' knowledge, there has been only 1 other published report of a primary gliosarcoma carrying an isocitrate dehydrogenase mutation. This rare genetic-histological combination highlights potential differences between glioblastoma and gliosarcoma and may warrant additional study.

scholarly journals Successful en Bloc Resection for Femoral Head Clear Cell Chondrosarcoma Without Biopsy: A Case Report

2021 ◽  
Author(s):  
Manabu Hoshi ◽  
Naoto Oebisu ◽  
Yoichi Ohta ◽  
Ayaka Tomimoto ◽  
Hiroaki Nakamura
Keyword(s):  
Femoral Head ◽  
Clear Cell ◽  
Surgical Margin ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Wide Resection ◽  
Low Grade ◽  
En Bloc ◽  
Postoperative Function ◽  
Clear Cell Chondrosarcoma

Abstract Background: Clear cell chondrosarcoma (CCCS) is a rare, low-grade, malignant chondrogenic bone tumour. This tumour commonly occurs at the epiphysis of long bones, particularly in the proximal femur. Case presentation: This report describes a 58-year-old man with right hip pain since 5 months. Plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT) revealed the characteristic appearance of chondroid mineralisation in the right femoral head, suggesting typical CCCS. Although a biopsy is the gold standard for definite diagnosis before treatment, wide resection with removal of the biopsy tract is thought to affect negatively affect surgical margin and postoperative hip function. En bloc resection without a biopsy and a hip hemiarthroplasty were performed instead. The pathological diagnosis was CCCS, and an adequate surgical margin was obtained. No local recurrence or distant metastases were found, and postoperative function was excellent at the final follow-up. Conclusion: The femoral head is a typical location of CCCS. Wide resection with adequate margins is the main treatment strategy for CCCS. When radiological features are typical, performing an en bloc resection without performing a biopsy is an acceptable treatment that may improve patient outcomes.

Partial Sacrectomy for Resection of a Sacral Chordoma: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E412-E412
Author(s):  
Martin Julian Gagliardi ◽  
Alfredo Guiroy ◽  
Alfredo Sícoli ◽  
Nicolás Gonzalez Masanés ◽  
Alejandro Morales Ciancio
Keyword(s):  
Osteolytic Lesion ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Wide Resection ◽  
Resection Margins ◽  
Low Grade ◽  
En Bloc ◽  
Ct Guided ◽  
Sacral Chordoma ◽  
Sacrococcygeal Region

Abstract Sacral chordomas are infrequent tumors that arise from remnants of the notochord. They are most often found in the sacrum and skull-base.1,2 These lesions rarely metastasize and usually have an indolent and oligosymptomatic clinical course. Chordomas show low sensitivity to standard radiation therapy and chemotherapy. Operative resection with wide resection margins offers the best long-term prognosis, including longer survival and local control.1,3 However, achieving a complete resection with oncological margins may be difficult because of the anatomic complexity of the sacrococcygeal region.4 The main complications of sacral resection include infections, wound closure defects, and anorectal and urogenital dysfunction. The rate of these complications is significantly increased when the tumor involves the S2 level or above. We report the case of a 64-yr-old male who presented with progressive sacrococcygeal pain and a feeling of incomplete evacuation. A heterogeneous, osteolytic lesion was found at the sacrococcygeal region. Full body imaging tests were negative for other lesions. A computed tomography (CT) guided biopsy was made. We usually use the midline approach in case we have to include the needle path in the resection. The pathology confirmed a sacrococcygeal, low-grade chordoma. We decided to perform an en bloc resection. A posterior, partial sacrectomy was planned distal to the S4 level.

scholarly journals Endoscopic Resection of Ampullary Tumours: Long-term Outcomes and Adverse Events

2019 ◽  
Vol 3 (1) ◽  
pp. 17-25
Author(s):  
Ali Alali ◽  
Alberto Espino ◽  
Maria Moris ◽  
Myriam Martel ◽  
Ingrid Schwartz ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
Long Term Outcomes ◽  
En Bloc ◽  
Tertiary Center

Abstract Background The management of ampullary lesions has shifted from surgical approach to endoscopic resection. Previous reports were limited by small numbers of patients and short follow-up. The aim of this study is to describe short- and long-term outcomes in a large cohort of patients undergoing endoscopic ampullectomy. Methods Retrospective study of endoscopic ampullectomies performed at a tertiary center from January 1999 to October 2016. Information recorded includes patient demographics, clinical outcomes, lesion pathology, procedural events, adverse events and follow-up data. Results Overall, 103 patients underwent endoscopic resection of ampullary tumours (mean age 62.3 ± 14.3 years, 50.5% female, mean lesion size 20.9 mm; 94.9% adenomas, with a majority of lesions exhibiting low-grade dysplasia (72.7%). Complete endoscopic resection was achieved in 82.5% at initial procedure. Final complete endoscopic resection was achieved in all patients with benign pathology on follow-up procedures. Final pathology showed that 11% had previously undiagnosed invasive carcinoma. Delayed postprocedure bleeding occurred in 21.4%, all of which were managed successfully at endoscopy. Acute pancreatitis complicated 15.5% of procedures (mild in 93.8%). Perforation occurred in 5.8%, all treated conservatively except for one patient requiring surgery. Piecemeal resection was associated with significantly higher recurrence compared to en-bloc resection (54.3% versus 26.2%, respectively, P = 0.012). All recurrences were treated endoscopically. Conclusion Endoscopic ampullectomy appears both safe and effective in managing patients with ampullary tumours in experienced hands. Most adverse events can be managed conservatively. Many patients develop recurrence during long-term follow-up but can be managed endoscopically. Recurrence rates may be reduced by performing initial en-bloc resection.

scholarly journals LASER EN-BLOC RESECTION OF NON-MUSCLE-INVASIVE BLADDER CANCER: CLINICAL AND MORPHOLOGICAL SPECIFICITIES

2018 ◽  
Vol 14 (3) ◽  
pp. 78-84
Author(s):  
L. O. Severgina ◽  
N. I. Sorokin ◽  
A. M. Dymov ◽  
D. G. Tsarichenko ◽  
D. V. Enikeev ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Resection Margin ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Postoperative Outcomes ◽  
Invasive Bladder Cancer ◽  
Low Grade ◽  
Muscle Invasive Bladder Cancer ◽  
En Bloc ◽  
Muscle Invasive

Objectives to enhance the morphological diagnostic complex in order to predict postoperative outcomes in a more accurate way and to optimize patients with non-muscular invasive bladder cancer treatment.Materials and methods. The study included 34 patients from 25 to 71 years old underwent laser en-block resection, the most of them were males – 28. In 9 cases multiple carcinomas (2 or more) were found. Huge tumors (2 cm or more in one dimension) were resected in 6 patients. Results. The major part of tumors removed (n = 22) histologically appeared to be papillary urothelial carcinomas with low grade of malignancy and PUNLMP; in 6 cases G2 was verified, one tumor with high malignancy potention – G3. In 3 patients intramuscular invasion was found (invasive carcinoma T2) excluding them from the study.Discussion. Laser en-block resection of non-muscle-invasive bladder cancer appears to be the most optimal approach in operative treatment that provides representative histological material. For correct morphological estimate we recommend either to expand the resection zone to 1 cm which allows to remove circular resection margin or to take extra pinch biopsy from tumor crater (vertical margin). In 3 patients from our study positive circular margin was revealed histologically whereas foci of perineural and perivascular invasion were found in one case. A new subgrading of stage T1 depending on intramuscular invasion depth was suggested whereas the main criteria is the muscularis mucosae involvement.Conclusion. Morphological estimate of circular resection margin provides an ability to predict postoperative outcomes and correct the treatment in one or another way. Subgrading for T1-stage tumors is recommended for following correct postoperative prognosis and possibility of tumor recurrence.

scholarly journals Contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection: a technique for oncological resection of posterolateral spinal tumors

2017 ◽  
Vol 26 (3) ◽  
pp. 275-281 ◽  
Author(s):  
Viren S. Vasudeva ◽  
Alexander E. Ropper ◽  
Samuel Rodriguez ◽  
Kyle C. Wu ◽  
John H. Chi
Keyword(s):  
Spinal Column ◽  
Progression Free Survival ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
High Morbidity ◽  
Low Grade ◽  
En Bloc ◽  
Bloc Spondylectomy ◽  
Pars Interarticularis

En bloc resection of tumors involving the spinal column is technically challenging and is associated with high morbidity to the patient due to the proximity of critical neurological and vascular structures and the destabilizing nature of this surgery. Nevertheless, evidence has shown improved progression-free survival with en bloc resection for certain low-grade malignant and aggressive benign musculoskeletal tumors. To avoid the morbidity of en bloc spondylectomy in patients with tumors localized to the lateral and posterolateral spinal column, the authors have found that the goals of surgery can be accomplished through a contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER). They reviewed their series of 5 patients who underwent successful tumor removal through a COPPER approach. These patients were all found to harbor spinal column tumors involving the posterolateral elements that, based on pathology, would benefit from en bloc resection. Tumor pathology included chondrosarcoma, leiomyosarcoma, osteoblastoma, and liposarcoma. Resections were performed by completing ipsilateral facetectomies above and below the lesion and ipsilateral pedicle osteotomies from a contralateral approach following hemilaminectomy. By disarticulating the posterolateral elements while carefully protecting the thecal sac, the tumors were removed en bloc along with the affected lamina, pedicles, pars interarticularis, and spinous processes, allowing tumor-free margins. This technical report suggests that the COPPER approach is safe and effective for en bloc resection of tumors involving the posterolateral aspect of the spinal column with tumor-free margins and that it eliminates the need for anterior column reconstruction.

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