Complete resection is the standard of care for thymic malignancies. There is still a debate about the optimal surgical approach for thymic tumors, particularly regarding long-term oncological outcome. This study aimed to compare videothoracoscopic surgery (VTS) with open surgery for thymic malignancies, regarding perioperative and long-term oncological outcomes. A prospective study ran from 2010 to 2019. Patients with thymoma or thymic carcinoma underwent complete thymectomy via VTS or open surgery and were followed up. The long-term oncological outcome was disease recurrence. There were 29 patients in the VTS group and 35 patients in the open group with an average follow-up period of 80 months. The VTS approach significantly shortened operative duration (89.7 versus 116.9 min), caused less blood loss (56.9 versus 176.3 ml), reduced pain score (4.8 versus 6.7), and shortened chest drainage duration (2.1 versus 3.1 days) as well as hospital stay (5.1 versus 7.7 days). The two groups were comparable in long-term oncological outcome (two recurrences in the VTS group and one in the open group). Compared to open surgery, VTS leads to superior perioperative outcomes and a comparable long-term oncological outcome. The authors advocate the VTS approach as a routine option for the surgery of thymic malignancies. Videothoracoscopic surgery is less traumatic and has faster recovery times than open surgery, with a comparable long-term oncological outcome.

The aim of this study was to evaluate the safety and efficiency of thyroid surgery by the experienced surgeon under superficial cervical block anesthesia (SCB). A total of one hundred fourty seven consecutive patients, who underwent a total thyroidectomy under SCB anesthesia for thyroid disorder, between January 2010 and January 2018, were reviewed in this study. Total throidectomy was performed in all patients under SCB by the two experienced surgeon 75% of patients were female and the remainder 25% male. Mean age 60±14 (±standart deviation) years. Conversion rate to general anesthesia was 4%. The mean operation time lasted 74 ± 24 minutes. Sensorial block 98± 24 started in 24 seconds and continued for 202 ± 18 minutes. During the operation, the patients were asleep and were awake in the postoperative period. SCB reduced analgesic need The most common introperative side effect of SCB was snore in 24.4% of the patients. Patient and surgeon satisfaction was good for SCB. Postoperative complications are bleeding in 2 % of the patients, permanent recurrent nerve injury in 0.6% of the patients and permanent hipoparathyroidi in 2% of the patients.. Hospital stay was 1 ± 0.2 day. Total thyroidectomy performed by experienced surgeons in the selected group patients under SCB anesthesia is safe and effective.

Background:
\nHilar cholangiocarcinoma (HCCA) arises from the confluence of the common hepatic duct and has a poor prognosis. If resectable, an extended left (eLH) or right hemihepatectomy (eRH) is usually required to provide oncological clearance. We reviewed outcomes for patients with HCCA managed at our centre.
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\nMethods:
\nElectronic records of patients referred to our centre for HCCA were retrospectively reviewed. The Kaplan–Meier method was used to estimate overall survival (OS) with the log rank test used for significance (p < 0.05). A Cox regression was performed to ascertain factors that may influence survival.
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\nResults:
\n156 HCCA patients were identified (44 resected versus 112 non-resected). Resected patients had longer OS compared to non-resected patients (50.3 versus 9.8 months, p < 0.001). Patients who underwent an eLH (n = 15) had significantly longer OS at 3 years compared to eRH patients (67.7 vs. 42.1%, respectively; p = 0.007). An eLH was an independent predictor of survival (HR 0.43, p = 0.04). Lymph node positivity (n = 23, hazard ratio 1.72, p = 0.027) and the presence of microvascular invasion (n = 28, hazard ratio 1.78, p = 0.047) were independent predictors of mortality. The frequency of lymph node positivity and microvascular invasion did not differ between eLH and eRH patients (p > 0.05).
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\nConclusion:
\nPatients undergoing an eLH for HCCA have significantly better long-term outcomes compared to those undergoing eRH, independent of other pathological variables. The functional liver remnant (FLR) is usually smaller following eRH, resulting in a higher risk of post-operative liver failure. Combining CT volumetry with PVE may result in better prediction and optimisation of the FLR in the context of eRH for HCCA.
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\nNovel findings:
\nAn extended left hemihepatectomy is an independent predictor of survival; investigation into the precise interaction between left- and right-sided resections and pre- and post-embolization liver volume is warranted.

Background We performed this study to investigate the feasibility and clinical and financial benefit of an enhanced recovery after surgery (ERAS) protocol in elderly patients undergoing colorectal resections.

Introduced in the mid-1990s, minimally invasive pancreatic surgery (MIPS) developed slowly over the next two decades, and its real-life benefits remained unclear. In this review, the current status and evidence on the most common types of MIPS, such as minimally invasive pancreatoduodenectomy (MIPD), distal pancreatectomy, enucleation, and central pancreatectomy are presented. Minimally invasive distal pancreatectomy (MIDP) is the most frequently used procedure among these, and its indications are nowadays expanding. MIDP for benign and low-grade malignant tumors is advantageous compared to the open approach, suggesting less intraoperative blood loss, shorter hospital stay, faster functional recovery, and better quality of life. The oncological adequacy of MIDP in pancreatic cancer is unclear, as no randomized trials have been published. In contrast, MIPD is a technically challenging procedure performed in a small number of centers and in a selected group of patients. Its use remains controversial, as conflicting data have been reported in the literature. Annual volume and learning curve seem to be the key determinants of safety in MIPD. Minimally invasive pancreatic enucleation and central pancreatectomy are less common. Although one randomized trial was published on minimally invasive vs. open central pancreatectomy, current evidence on these procedures is mostly based on retrospective, single-institution series clearly affected by selection bias and small sample size. Well-designed prospective studies based on national registries are needed to expand knowledge on MIPS and determine its role in pancreatic surgery. To facilitate further development of MIPS, it has to integrate effectively with the outcome-improving effect of a dedicated pancreatic team.

Central biliary metastasis from colorectal cancer (CRC) is a rare manifestation. Given the rarity of the lesion, cases with central biliary metastasis from CRC pose challenges in identifying the proper treatment strategy. We present a case of stage IV CRC with synchronous multiple liver metastases and central biliary invasion. We also conducted a literature search and reviewed the reports on central biliary metastasis of CRC treated by major hepatectomy combined with extrahepatic bile duct resection. The patient underwent colon resection, partial hepatectomy, and transileocecal portal embolization (TIPE) as the first procedure, which was followed by an extended right hepatectomy and extrahepatic bile duct resection. Adjuvant chemotherapy was introduced, and the patient was doing well with no recurrence at 17 months after the first procedure. A liberal radical and aggressive resection in a multimodal treatment strategy could offer a favorable outcome in patients with a rare central biliary manifestation of CRC.

Clinical decision-making around the management of liver-limited stage IV colorectal cancer involves careful assessment of the potential risks and benefits of surgery. This balance can often be optimised through appropriate patient selection to ensure long-term benefit of any operation, with fastidious perioperative care to minimize risk. We reviewed selected relevant articles from the existing literature. Multi-platform imaging is routinely used to determine distribution of disease and whether lesions are technically resectable, but what remains less clear is how to identify patients in whom resection is likely to deliver long-term benefits. A number of prognostic markers have been identified, with growing interest in direct assessment of tumour biology; genotyping of RAS status is routine in specific situations. Following a multidisciplinary team decision to proceed to surgery, patients undergo perioperative assessment and optimisation. Cardiopulmonary exercise testing helps to stratify perioperative risk: patients with low uptake of oxygen at the anaerobic threshold are known to have worse perioperative outcomes, and prehabilitation may offer the chance to reduce this risk. Intraoperative anaesthetic management is on a patient-by-patient basis but sub-normal hydration, epidural anaesthesia and steroids play a key role. Enhanced recovery after surgery programmes have improved perioperative outcomes while providing a potential economic benefit. Despite very good perioperative results, surgical management is not curative for the majority of patients, highlighting the need to further refine patient selection and definition of treatment aim on a patient-by-patient basis.

Solid pseudopapillary tumours, also known as Frantz’s tumours, are rare pancreatic lesions which usually occur in young 20–30 year-old women. They account for about 2% of all exocrine pancreatic tumours. They often present with vague abdominal pain and the diagnosis is frequently an incidental finding. In this case series and narrative review, we attempt to update the current standpoint on primary pseudopapillary tumours. In this paper we present a case series of three subjects (2 females and 1 male) who were diagnosed with primary pseudopapillary tumours. Their treatment and follow-up is described in detail. These tumours will be discussed in the context of a literature review. Surgical resection remains the primary method of treatment for this subtype of pancreatic tumours. The prognosis is excellent in patients who undergo resection.

SummaryWhereas liver resection for colorectal metastasis has become standard of care, hepatectomy in patients with non-colorectal metastases remains controversial, mainly due to a heterogeneous tumor biology and missing data from prospective trials. This review aims at giving an overview about the indications and limits of liver surgery in patients with an advanced disease of a non-colorectal malignancy. Even though prospective trials are largely missing, results from retrospective studies indicate a survival benefit for liver resection in selected patients. Thus, in metastasized patients, treatment strategies should be developed in a multidisciplinary tumor board including an experienced liver surgeon.