Gastric cancer is the most common cancer in Korea, and is often treated by surgical resection. Many postoperative complications or tumor recurrence, however, are managed by the use of imaging-guided interventions. This review describes the spectrum of postoperative complications that occur following gastrectomy, with an emphasis on the interventional procedures used to manage postoperative complications and tumor recurrence.
Gastrectomy ; Korea ; Neoplasm Recurrence, Local ; Postoperative Complications ; Radiography, Interventional ; Recurrence ; Stomach Neoplasms ; Tomography, X-Ray Computed

Telangiectatic osteosarcoma is a rare and special variant of osteogenic sarcoma with distinct radiologic, gross and microscopic features. This tumor is predominantly lytic, destructive tumor without sclerosis on roentgenogram, and is soft and cystic on gross examination. Histologically aneurysmally dilated spaces lined or traversed by stromal cells producing osteoid are noted. This report concerns a case of telangiectatic osteosarcoma occurring in a 7 years old boy. He presented with pathologic fracture of the right distal tibia, followed by a purely lytic lesion on X-ray examination. This lesion recurred five times during a span of one year. Microscopic features of the biopsy specimen was difficult to differentiate from aneurysmal bone cyst because of prominant blood-filled cyst formation. It was finally identified as osteosarcoma from the below-knee amputation specimen through the close examination for anaplastic osteoid-producing stromal cells in the septa that separate the blood cysts.
Aneurysm/complications/diagnosis ; Child ; Diagnosis, Differential ; Humans ; Male ; Neoplasm Recurrence, Local ; Osteosarcoma/complications/*pathology ; Tibia

OBJECTIVETo compare the total thyroidectomy or subtotal resection and gland lobe and isthmus lobectomy as initial treatment to TNM stage I and II differentiated thyroid cancer. The difference between recurrence rate and surgical complications were analysed.

METHODSThe literatures published between 1972-2012 were searched in Pubmed, Medline, Wanfang database, Chinese Biomedical Literature Database, Chinese scientific Journals database and China National Knowledge Infrastructure. According to the inclusion and deletion criteria, 17 articles were included to compare the postoperative recurrence and complications in randomized controlled or case-control studies, involving 13 articles in recurrence rate and 11 articles in complications.RevMan5.0 software package was used to perform meta-analysis.

RESULTSThirteen articles involved with the recurrence rate, the total case number was 3511. Among these cases, 414 recurred, overall recurrence rate was 11.59%, of which, 150 recurred cases in total or subtotal resection group (experimental group), the recurrence rate was 6.51%; 264 recurred cases in gland lobe lobectomy plus isthmus group (control group), the recurrence rate was 21.83%. Comparing the two groups, the odds ratio (OR) and their 95% confidence interval (95%CI) was 0.26 [0.21,0.33], Z value was 11.33, P < 0.01, which showed that the recurrence rate in experimental group was significantly lower than that in control group.Eleven articles involved with the complications, the total case number was 2388, 166 cases had postoperative complications. The complication rate was 6.95%, of which, 109 cases in experimental group, the complication rate was 8.52%; 57 cases in control group, the complication rate was 5.15%. Compared with the two groups, OR values and their 95%CI was 3.63 [2.47, 5.33], Z was 6.58, P < 0.01, the experimental group had significantly higher incidence of complications.

CONCLUSIONFor I and II differentiated thyroid cancer, total thyroidectomy or subtotal resection may reduce the chance of recurrence, but the postoperative complications is higher; while gland lobe and isthmus lobectomy has lower postoperative complications, but may increase the risk of relapse.

Humans ; Neoplasm Recurrence, Local ; epidemiology ; Postoperative Complications ; epidemiology ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; adverse effects ; methods

We reported a case of children's OSAHS caused by the huge fibrolipoma in pharynx nasalis. The patient was a 10-years-old child who went to the hospital with the chief complaint of "Snoring and mouth breathing during sleep for 10 years". Imaging tests found one huge tumor in pharynx nasalis before the operation. The tumor was resected totally. The postoperative pathological diagnosis was fibrolipoma. No recurrence was noted during the follow-up visit one year postoperatively. The clinical features, diagnosis, treatment, pathology and prognosis were reviewed herein.
Child ; Humans ; Lipoma ; complications ; surgery ; Neoplasm Recurrence, Local ; Pharynx ; pathology ; Prognosis ; Sleep Apnea, Obstructive ; etiology ; Snoring

A 41 years female patient was hospitalized with hoarseness for three months, without cough, expectoration and dyspnea. The symptom had no relief by application of antibiotics. Electronic laryngoscope showed that there were the grey neoplasms under subglottic anteriou commissure with broad base and slightly rough surface, and bilateral vocal cords were normal; throat CT showed subglottic irregular high density and calcification. The subglottal tumor resection was performed under the general anesthesia and laryngoscope CO2 laser assisted. In the operation, we found that the tumor was hard with surface of thin mucosa tissue, and there was white bone tissue under it. The removing tumor was about 0. 8 cm X 0. 6 cm X 0. 3 cm and was diagnosed as subglottic osteoma by pathologic examine. There was no recurrence in three months follow-up.
Adult ; Female ; Glottis ; pathology ; Hoarseness ; complications ; Humans ; Lasers, Gas ; Neoplasm Recurrence, Local ; Osteoma ; diagnosis

To explore the diagnosis,treatment,surgical approach and prognosis of parapharyngeal space tumors.The clinical data of 188 patients with parapharyngeal space tumor who were treated from January 2007 to December 2016 were analyzed retrospectively.All patients underwent imaging examination before operation.Surgical approach was as follows:transcervical approach applied in 159 cases,endoscopic-assisted transnasal approach in 9 cases,transcervical-transmandibular approach in 8 cases,transcervical-transparotid approach in 8 cases,transoral approach in 7 cases,and infratemporal fossa approach in 4 case.Of the 188 cases,the tumor was benign in nature in 168 cases(89%)and malignant in 20 cases(11%).Complications occurred in 28(15%)patients,with the most common symptom being hoarseness.168 cases of benign tumors were followed up for 10 months to 10 years,and 3 cases were lost and 4 cases had recurrence.All cases underwent re-operation.Patients with malignant tumors received combined treatment after surgery,and 3 cases were lost to follow-up,1 case died of recurrence 9 months after surgery,the rest survived.Surgery is the preferred method for treating parapharyngeal space tumors and postoperative recurrence rate is pretty low.Endoscopy provides a new surgical management method,helping to reduce postoperative complications and recurrence rate.
Endoscopy ; Humans ; Neoplasm Recurrence, Local ; Pharyngeal Neoplasms ; complications ; diagnosis ; surgery ; Retrospective Studies

Objective: To study the clinical diagnosis and treatment strategies for vein-related pulsatile tinnitus patients with transverse sinus stenosis. Methods: The clinical data of patients with vein-related pulsatile tinnitus, from January 2015 to August 2019, were collected,whose digital subtraction angiography showing transverse sinus stenosis. Taking December 2019 as the last follow-up time, we analyzed the clinical characteristics, CT angiography and digital subtraction angiography results, lumbar puncture pressure and cerebrospinal fluid composition, and other auxiliary examination results (pure tone audiometry, fundus examination of papilledema, carotid ultrasonography, bone density screening, endocrinous test), as well as tinnitus handicap inventory, treatment options and follow-up results. Results: 83 patients were enrolled with female of 89.2% (74/83) and male of 10.8%(9/83); 65.1% (54/83) with right tinnitus, 31.3% (26/83) with left tinnitus, and 3.6% (3/83) with bilateral tinnitus; 67.5% (56/83) with right dominant sinus, 19.3% (16/83) with left dominant sinus, 13.3% (11/83) with bilateral equalization; Bilateral and ipsilateral stenosis accounted for 55.4% and 44.6% respectively; BMI was overweight or obese in 41 cases (49.4%, 41/83). Patients with tinnitus handicap inventory level three or above accounted for 79.5% (66/83). Eventually, 33 patients chose conservative observation (39.8%, 33/83), 40 patients (48.2%), 8 patients (9.6%) and 2 patients (2.4%) received sigmoid sinus-related surgery, interventional surgery, or emissary vein occlusion respectively. The mean follow-up time of 74 patients was 26.2 months. The data of 48 surgery patients showed that the pressure differences of venous sinus among the recurrent patients were more obvious; Interventional surgery with simultaneous stenting placement was effective. Tinnitus did not decrease in two patients with emissary vein occlusion. Analysis of 26 patients with lumbar puncture revealed eight cases of normal cranial pressure and 18 cases of high cranial pressure. The sinus pressure difference between the two groups was different (P=0.025), but the difference of age of onset, concomitant symptoms, BMI, proportion of empty sella or papilledema was not statistically significant (P>0.05). Conclusions: The evaluation of patients with vein-related pulsatile tinnitus requires a standardized procedure. Papilledema cannot be used as a sensitive indicator in patients with early intracranial hypertension. Venous sinus pressure difference may be one of the indicators of intracranial hypertension, and the lumbar puncture is the gold standard for the diagnosis. Weight loss can be used as a conservative treatment during the observation period. Significant sinus stenosis is a risk factor for recurrence in patients undergoing sigmoid sinus surgery. Interventional stenting is an effective treatment for tinnitus secondary to transverse sinus stenosis.
Constriction, Pathologic/complications* ; Cranial Sinuses ; Female ; Humans ; Male ; Neoplasm Recurrence, Local ; Stents ; Tinnitus/etiology*

Objective: To investigate the surgical indications and perioperative clinical outcomes of pelvic exenteration (PE) for locally advanced, recurrent pelvic malignancies and complex pelvic fistulas. Methods: This was a descriptive study.The indications for performing PE were: (1) locally advanced, recurrent pelvic malignancy or complex pelvic fistula diagnosed preoperatively by imaging and pathological examination of a biopsy; (2)preoperative agreement by a multi-disciplinary team that non-surgical and conventional surgical treatment had failed and PE was required; and (3) findings on intraoperative exploration confirming this conclusion.Contraindications to this surgical procedure comprised cardiac and respiratory dysfunction, poor nutritional status,and mental state too poor to tolerate the procedure.Clinical data of 141 patients who met the above criteria, had undergone PE in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to September 2022, had complete perioperative clinical data, and had given written informed consent to the procedure were collected,and the operation,relevant perioperative variables, postoperative pathological findings (curative resection), and early postoperative complications were analyzed. Results: Of the 141 included patients, 43 (30.5%) had primary malignancies, 61 (43.3%) recurrent malignancies, 28 (19.9%) complex fistulas after radical resection of malignancies,and nine (6.4%)complex fistulas caused by benign disease. There were 79 cases (56.0%) of gastrointestinal tumors, 30 cases (21.3%) of reproductive tumors, 16 cases (11.3%) of urinary tumors, and 7 cases (5.0%) of other tumors such mesenchymal tissue tumors. Among the 104 patients with primary and recurrent malignancies, 15 patients with severe complications of pelvic perineum of advanced tumors were planned to undergo palliative PE surgery for symptom relief after preoperative assessment of multidisciplinary team; the other 89 patients were evaluated for radical PE surgery. All surgeries were successfully completed. Total PE was performed on 73 patients (51.8%),anterior PE on 22 (15.6%),and posterior PE in 46 (32.6%). The median operative time was 576 (453,679) minutes, median intraoperative blood loss 500 (200, 1 200) ml, and median hospital stay 17 (13.0,30.5)days.There were no intraoperative deaths. Of the 89 patients evaluated for radical PE surgery, the radical R0 resection was achieved in 64 (71.9%) of them, R1 resection in 23 (25.8%), and R2 resection in two (2.2%). One or more postoperative complications occurred in 85 cases (60.3%), 32 (22.7%)of which were Clavien-Dindo grade III and above.One patient (0.7%)died during the perioperative period. Conclusion: PE is a valid option for treating locally advanced or recurrent pelvic malignancies and complex pelvic fistulas.
Humans ; Pelvic Exenteration/methods* ; Pelvic Neoplasms/surgery* ; Retrospective Studies ; Neoplasm Recurrence, Local/surgery* ; Postoperative Complications

OBJECTIVE: To investigate the safety and efficacy of reinforced radiculoplasty in the treatment of symptomatic sacral Tarlov cysts (TCs). METHODS: A retrospective analysis was performed on the clinical data and follow-up data of 71 patients with symptomatic sacral TCs who underwent reinforced radiculoplasty in the Neurosurgery Department of Peking University Third Hospital from June 2018 to March 2021. All the operations were performed under neuroelectrophysiological monitoring. Intraoperative cyst exploration, partial resection of the cyst wall, narrowing of the leak, nerve root sleeve radiculoplasty and artificial dural reinforcement were performed. The incidence of postoperative complications and new neurological dysfunction was analyzed. Visual analogue scale (VAS) was used to assess the changes of pain before and after surgery. The Japanese Orthopedics Association (JOA) low back pain score was used to evaluate the changes in nerve function before and after surgery. RESULTS: In the study, 71 patients had 101 TCs, 19 (18.8%) TCs originated from the left S1 nerve, 26 (25.7%) originated from the left S2 nerve, 3 (3.0%) originated from the left S3 nerve, 14 (13.9%) originated from the right S1 nerve, 33 (32.7%) originated from the right S2 nerve, 6 (5.9%) originated from the right S3 nerve, all the TCs underwent reinforced radiculoplasty. Deep infection (1 case), subcutaneous effusion (1 case), fat li-quefaction (1 case) and urinary tract infection (4 cases) were recorded postoperatively. The patients were followed up for 12-43 months (median, 26 months). Two cases had new urinary retention after operation, and the catheter was removed at the end of the first and second months respectively. One case had new fecal weakness, which improved after 3 months. Compared with preoperation, VAS decreased significantly at the last follow-up [median, 6 (4-9) vs. 1 (0-5), Z=-7.272, P < 0.001], JOA score increased significantly [median, 20 (16-25) vs. 27 (18-29), Z=-7.265, P < 0.001]. There were 18 cured cases (25.4%), 41 excellent cases (57.7%), 8 effective cases (11.3%), and 4 invalid cases (5.6%). The total efficiency was 94.4% (67/71). Two (1.98%) cysts recurred. CONCLUSION For patients with symptomatic sacral TCs, reinforced radiculoplasty can significantly improve the pain and nerve function, which is safe and reliable.
Humans ; Tarlov Cysts/epidemiology* ; Retrospective Studies ; Neoplasm Recurrence, Local/complications* ; Cysts/surgery* ; Pain

OBJECTIVETo explore the accuracy of endoscopic ultrasound (EUS) in preoperative staging of rectal cancer and to guide the treatment of transanal endoscopic microsurgery (TEM) in early rectal cancer.

METHODSClinical data of 80 patients with rectal cancer receiving EUS examination for preoperative staging in our department between June and December 2012 were retrospectively analyzed. Consistence comparison of EUS preoperative staging and pathological staging was performed to identify the accuracy of EUS preoperative staging. All the patients underwent operation within 1 week after EUS examination. According to preoperative staging, early rectal cancer(Tis or T1N0M0) patients with lesions less 20 cm to anus underwent TEM.

RESULTSThe overall accuracy of EUS for preoperative T stage was 68.8%(55/80), and for T1, T2, T3, T4 was 91.3%(73/80), 83.8%(68/80), 77.5%(62/80), 85.0%(67/80), which had a good consistence with postoperative pathological T staging(Kappa=0.562). The overall accuracy of EUS for preoperative N stage was 52.7%(39/74), and for N0, N1, N2 stage was 64.9%(48/74), 55.4%(41/74), 85.1%(63/74), which had a poor consistence with postoperative pathological N staging(Kappa=0.235). Six patients underwent TEM successfully, with mean operation time 99(65 to 123) min, without intraoperative and postoperative complication, and were discharged 2-3 days after operation. Enteroscope showed good recovery 1 month later. Pathology confirmed that all the lesions were early rectal cancer. During postoperative follow-up of 14.8 (11 to 19) months, there was no local recurrence and distant metastasis.

CONCLUSIONPreoperative EUS has a good accuracy with pathologic T stage, and can guide TEM in early rectal cancer.

Anal Canal ; Endosonography ; Humans ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Postoperative Complications ; Rectal Neoplasms ; Retrospective Studies ; Transanal Endoscopic Microsurgery