PURPOSE: Laparoscopic surgery has become the mainstream surgical operation due to its stability and feasibility. Even for liver surgery, the laparoscopic approach has become an integral procedure. According to the recent international consensus meeting on laparoscopic liver surgery, laparoscopic left lateral sectionectomy (LLS) might be a new standard of care for left lateral surgical lesions. This study was designed to compare open LLS to laparoscopic LLS. METHODS: In total, 82 patients who had undergone LLS at Chonnam National University Hwasun Hospital between 2008 and 2015 were enrolled in this study. Among them, 59 patients underwent open LLS and 23 underwent laparoscopic LLS. These two groups were compared according to general characteristics and operative outcomes. RESULTS: The data analysis results showed that laparoscopic liver resection is superior to open liver resection in terms of the amount of bleeding during the operation and the duration of hospital stay. There was no statistical difference between the two groups in terms of operation time (p value=0.747). The amount of bleeding during the operation was 145.5±149.4 ml on average for the laparoscopic group and 320±243.8 ml on average for the open group (p value=0.005). The mean duration of hospital stay was 10.7±5.8 days for the laparoscopic surgery group and 12.2±5.1 days for the open surgery group (p value=0.003). CONCLUSION: This study showed that laparoscopic LLS is safe and feasible, because it involves less blood loss and a shorter hospital stay. For left lateral lesions, laparoscopic LLS might be the first option to be considered.
Consensus ; Hemorrhage ; Humans ; Jeollanam-do ; Laparoscopy ; Length of Stay ; Liver ; Standard of Care ; Statistics as Topic

Lymphangiomas are rare congenital benign tumors arising from the lymphatic system, and are mostly encountered in the neck and axillary regions of pediatric patients (95%). Lymphangioma of the pancreas is extremely rare accounting for less than 1% of these tumors. We report here on a case of pancreatic cystic lymphangioma. A 54-year-old woman presented with intermittent postprandial abdominal discomfort and radiating back pain. Abdominal computed tomography scan revealed 8 x 6.5 cm hypodense cystic mass arising from the tail of the pancreas without septa or solid component. The initial impression was a pancreatic pseudocyst. The patient underwent distal pancreatectomy with splenectomy. The histopathologic and immunohistochemical study helped make the diagnosis of a pancreatic cystic lymphangioma. Herein, we report a case of pancreatic cystic lymphangioma mimicking pancreatic pseudocyst and review the relevant medical literature.
Accounting ; Back Pain ; Female ; Humans ; Lymphangioma ; Lymphangioma, Cystic ; Lymphatic System ; Middle Aged ; Neck ; Pancreas ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Splenectomy

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

A pancreatic hamartoma is a rare benign lesion that may be mistaken for malignancy. A pancreatic hamartoma can present with vague, non-specific symptoms, which can be difficult to diagnose despite modern diagnostic tools. We report here a pancreatic hamartoma diagnosed after surgical resection. A 52-year-old female presented with postprandial abdominal discomfort. Abdominal computed tomography and pancreatic magnetic resonance imaging revealed a 2.2 x 2.5-cm cystic mass in the pancreatic head. The patient underwent a pylorus-preserving pancreaticoduodenectomy. The histopathological and immunohistochemical studies helped make the diagnosis of pancreatic hamartoma. Here, we report a case of pancreatic hamartoma and review the relevant medical literature.
Female ; Hamartoma ; Head ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pancreas ; Pancreaticoduodenectomy

We report a case of Creutzfeldt-Jacob disease and review the relevant literatures. This 56-year-old male patient was admitted to our hospital with a history of rapidly progressing cognitive dysfunction, visual disturbance, gait disturbance, weakness, involuntary movement of lower extremities, and the symptoms of delirium. On mental status examination, he showed psychomotor retardation, speech disturbance, perseveration, disorientation, impairement of short-term and long-term memory, and inability of abstract thinking. He had a rapid downhill course, along with shakiness of trunk, rigidity of the limbs, myoclonus, confusion, and finally, inability to speak or move on the bedside. On electroencephalogram(EEG), continuous multifocal slow delta activities were found in all leads, especially in the right frontal areas. Brain biopsy showed, spongiosis with neuronal loss and gliosis noted at the cerebral cortex. These findings were compatible with Creutzfeldt-jacob disease.
Biopsy ; Brain ; Cerebral Cortex ; Delirium ; Dementia ; Dyskinesias ; Extremities ; Gait ; Gliosis ; Humans ; Lower Extremity ; Male ; Memory, Long-Term ; Middle Aged ; Myoclonus ; Neurons ; Thinking

Peribiliary cysts, known as cystic dilatation, of the extramural peribiliary glands of the bile duct are rare, and are usually detectable under conditions of pre-existing hepatobiliary diseases such as liver cirrhosis. Preoperative diagnosis is often difficult, because they are usually asymptomatic. Distinction of peribiliary cysts from premalignant or malignant cystic lesions is mandatory. Herein, we report a case of peribiliary cyst, which was preoperatively assumed as unilobar Caroli's diseases in healthy young patients and briefly discuss the management of the condition.
Bile Ducts ; Caroli Disease ; Dilatation ; Humans ; Liver Cirrhosis ; Liver Neoplasms

BACKGROUNDS/AIMS: The future liver remnant (FLR) is usually calculated as a ratio of the remnant liver volume (RLV) to the total functional liver volume (RLV/TFLV). In liver transplantation, it is generally accepted that the ratio of the graft volume to standard liver volume (SLV) needs to be at least 30% to 40% to fit the hepatic metabolic demands of the recipient. The aim of this study was to compare RLV/TFLV versus RLV/SLV as a predictor of postoperative liver function and liver failure. METHODS: CT volumetric measurements of RLV were obtained retrospectively in 74 patients who underwent right hemihepatectomy for a malignant tumor from January 2010 to May 2013. RLV and TFLV were obtained using CT volumetry, and SLV was calculated using Yu's formula: SLV (ml)=21.585 x body weight (kg)0.732 x height (cm)0.225. The RLV/SLV ratio was compared with the RLV/TFLV as a predictor of postoperative hepatic function. RESULTS: Postheptectomy liver failure (PHLF), morbidity, and serum total bilirubin level at postoperative day 5 (POD 5) were increased significantly in the group with the RLV/SLV < or =30% compared with the group with the RLV/SLV >30% (p=0.002, p=0.004, and p<0.001, respectively). But RLV/TFLV was not correlated with PHLF and morbidity (p=1.000 and 0.798, respectively). RLV/SLV showed a stronger correlation with serum total bilirubin level than RLV/TFLV (RLV/SLV vs. RLV/TFLV, R=0.706 vs. 0.499, R2=0.499 vs. 0.239). CONCLUSIONS: RLV/SLV was more specific than RLV/TFLV in predicting the postoperative course after right hemihepatectomy. To determine the safe limit of hepatic resection, a larger-scaled prospective study is needed.
Bilirubin ; Body Weight ; Humans ; Liver Failure ; Liver Transplantation ; Liver* ; Retrospective Studies ; Transplants

Primary sarcomas of the pancreas are extremely rare, accounting for 0.1% of malignant pancreatic (non-islet) neoplasms. Pancreatic leiomyosarcoma is a highly aggressive malignancy that spreads in a similar manner to gastric leiomyosarcoma, i.e., by adjacent organ invasion, hematogenous spread, and lymph node metastasis. These tumors are large at the time of diagnosis and are usually found at an advanced stage. We report a case of a 70-year-old female with intermittent right upper quadrant abdominal discomfort. Radiological, histopathological, and immunohistochemical studies revealed the tumor to be a primary leiomyosarcoma of the pancreas. Herein, we describe a patient with a primary leiomyosarcoma of the pancreas who presented with clinical and radiological findings indicative of a mass in the pancreatic head.
Accounting ; Aged ; Female ; Head ; Humans ; Leiomyosarcoma ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Sarcoma

Hamartoma of the spleen is a rare benign lesion and the pathogenesis of this is not completely understood. It is usually incidentally discovered during an operation or autopsy. Since the first report in 1861 by Rokitansky, less than 150 cases of splenic hamartoma have been documented in the literature to date. The majority of the patients with this tumor are asymptomatic. However, a few of these lesions are associated with clinical features such as hypersplenism, cirrhosis of the liver and spontaneous splenic rupture. Because there are no specific symptoms, tumor markers or radiologic results, it is usually difficult to make a diagnosis before surgery and the specimen pathology. We report here on three cases of splenic hamartoma (a 33-year-old man associated with thrombocytopenia, a 29-year-old woman with a 6-month history of left upper quadrant abdominal pain and a 43-year-old man with synchronous hepatocellular carcinoma) and we review the relevant literature.
Abdominal Pain ; Adult ; Autopsy ; Female ; Fibrosis ; Hamartoma ; Humans ; Hypersplenism ; Liver ; Spleen ; Splenic Rupture ; Thrombocytopenia ; Biomarkers, Tumor