Multiple endocrine neoplasia type 2A (MEN 2A) is a hereditary disorder characterized by medullary thyroid carcinoma (MTC), pheochromocytomas, and primary hyperparathyroidism. We present the case of a 28-year-old male diagnosed with MEN 2A, exhibiting bilateral MTC and bilateral pheochromocytomas. The patient underwent a total thyroidectomy with bilateral central lymph node dissection, followed by bilateral corticalsparing adrenalectomy (CSA) utilizing single-port (SP) robotic posterior retroperitoneoscopic approach. The patient’s blood pressure remained consistently stable at an average of 125/85 mmHg after surgery, and he was discharged without complications on postoperative day 5 with good postoperative recovery and patient satisfaction. Adrenal function was successfully preserved, allowing for gradual tapering of hormone replacement therapy. This case underscores the efficacy of SP robotic CSA in managing bilateral pheochromocytomas within the context of MEN 2A, highlighting its role in tumor resection while maintaining adrenal function. The minimally invasive nature of the SP robotic approach and CSA offered advantages including reduced operative time, diminished postoperative discomfort, and enhanced cosmetic outcomes. Nonetheless, careful patient selection and diligent long-term follow-up are imperative to monitor adrenal function and detect potential tumor recurrence.

Purpose: To date, no studies have been performed on staging based on the lymph node ratio (LNR) in elderly patients with gastric cancer who may require limited lymph node (LN) dissection due to morbidity and tissue fragility. We aimed to develop a new N staging system using the LNR in elderly patients with gastric cancer. Materials and Methods: The present study included patients aged over 75 years who underwent curative gastrectomy between January 1989 and December 2018.Clinicopathological data including the number of retrieved and metastatic LNs were collected and the LNR values were obtained (LNR = the number of metastatic LNs/the number of retrieved LNs). Eleven LNR groups with intervals of 0.1 were divided into four stages based on the inflection points at which the hazard ratio (HR) increased. Survival analysis was performed to evaluate the prognostic value of the LNR. Results: The four LNR stages included LNR0 (n=364), LNR1 (n=128), LNR2 (n=103), and LNR3 (n=10). In the multivariate analysis, both N staging and LNR staging exhibited significant prognostic values for predicting survival outcomes. However, the incremental change in the hazard ratio (HR) between consecutive stages was greater for the LNR staging than for the N staging (HRs: 1.607, 2.758, and 3.675 for N staging; 1.583, 3.514, and 10.261 for LNR staging). Conclusions LNR staging is more useful than N staging in predicting the prognosis in elderly patients with gastric cancer and may be used as a complement or alternative to N staging.

PURPOSE: Spontaneously ruptured hepatocellular carcinoma (srHCC) is known to be a life-threatening complication with poor prognosis. Although there are various treatment modalities, there is no definite treatment guideline. The purpose of this study was to review the surgical outcome and prognosis of srHCC treated with intraoperative radiofrequency ablation (RFA) and distilled water peritoneal lavage (DWPL). METHODS: From March 2012 to October 2018, 9 patients with srHCC who underwent emergent surgery were reviewed. After hematoma removal, intraoperative RFA and DWPL were applied to all patients. Hepatectomy was performed if necessary. Patients with multiple tumors, distant metastasis, and vascular tumor involvement in radiologic imaging were excluded. RESULTS: Six of 9 patients with diameters less than 7 cm were able to obtain hemostasis using RFA alone (RFA group). However, 3 patients with a tumor size of more than 10 cm underwent liver resection because they could not obtain hemostasis with RFA (hepatectomy only group). The RFA group had shorter operation time (148.3 ± 31.7 minutes vs. 251.7 ± 20.2 minutes, P < 0.05) and less red blood cell transfusion (5.8 ± 2.5 packs vs. 24.0 ± 11.5 packs, P < 0.05) than the hepatectomy only group. There was no peritoneal metastasis at long-term follow-up in the RFA group. Five-year recurrence-free survival rate was 0% in both groups. However, 5-year overall survival rate was better in the RFA group (83.3% vs. 0%, P < 0.05). CONCLUSION: Intraoperative RFA and DWPL are easy to perform and theoretically the best methods for managing relatively small srHCC.
Carcinoma, Hepatocellular ; Catheter Ablation ; Erythrocyte Transfusion ; Follow-Up Studies ; Hematoma ; Hemostasis ; Hepatectomy ; Humans ; Liver ; Neoplasm Metastasis ; Peritoneal Lavage ; Prognosis ; Rupture ; Survival Rate ; Water