Identification, Friend or Foe: Vimentin and α-Smooth Muscle Actin in Cancer-Associated Fibroblasts

ASO Author Reflections: A Negative Axillary Clinical Exam Adequately Identifies Clinically Node-Positive Patients who Downstage After NAC and are Candidates for SLNB

Perioperative Clinical Trials for Pancreatic Cancer in the National Clinical Trials Network

ASO Author Reflections: Advising a Woman with Ductal Carcinoma In Situ Regarding Various Treatment Options—A Complex Decision

The Clinical Significance of Strap Muscle Invasion in Papillary Thyroid Cancer on Local Recurrence: Is Less Surgery Warranted?

Pure Laparoscopic Anatomic Resection of the Segment 8 Ventral Area Using the Transfissural Glissonean Approach Abstract Background Pure laparoscopic anatomic resection of liver segment 8 still is rarely performed due to technical difficulties and the anatomic complexity.1,2 Limited resection of the segment 8 ventral area has been possible because the right anterior section can be divided into ventral and dorsal areas.3,4 This report describes the technique of pure laparoscopic anatomic resection of the segment 8 ventral area using the transfissural Glissonean approach. Methods A 43-year-old woman who had been taking oral contraceptives for 3 years was referred for treatment of a single nodular tumor located in the segment 8 ventral area. The surgical procedure involved the following steps: (1) dissection and clamping of the right Glissonean pedicle, (2) identification of the main portal fissure, (3) parenchymal dissection along the main portal fissure,5–8 (4) dissection and ligation of the segment 8 ventral portal pedicle, and (5) transection of the ischemic demarcation line of the segment 8 ventral area. Results The operative time was 180 min, and the estimated blood loss was 30 mL. The total Pringle maneuver time was 45 min. The final histopathologic diagnosis was an adenoma. The tumor size was 6 mm, and the resection margin was negative. The patient had an uneventful postoperative recovery, and she was discharged on postoperative day 3. Conclusion The transfissural Glissonean approach for laparoscopic anatomic resection of the segment 8 ventral area is a feasible and effective technique. Opening of the main portal fissure allows easy and direct access to the segment 8 ventral branch.

Editorial About: “A Prospective, Open-Label, Multicenter Phase II Trial of Neoadjuvant Therapy Using Full-Dose Gemcitabine and S-1 Concurrent with Radiation for Resectable Pancreatic Ductal Adenocarcinoma”

ASO Author Reflections: Survival for Stage III Melanoma—Where Do We Stand in the Current Landscape of Melanoma Therapies?

Laparoscopic Distal Pancreatectomy for Left-Sided Pancreatic Cancer Using the “Caudo-Dorsal Artery First Approach” Abstract Background Pancreatic cancer (PC) has serious malignant potential, thus requiring complete resection and adequate regional lymphadenectomy with tumor-free margins.1,2 A standard laparoscopic distal pancreatectomy (LDP) procedure for PC is not yet established due to lack of supportive evidence.3–6 Methods In our hospital, we first administered neoadjuvant chemoradiotherapy for resectable PC. Considering the benefits offered by a laparoscopic magnified caudo-dorsal view, we devised and standardized an LDP procedure for PC, which we employed in five patients with left-sided resectable tumors. First, the retroperitoneum was incised between the proximal jejunum and the inferior mesenteric vein with the transverse colon pushed up ventrally and cranially and with the proximal jejunum moved to the right. Then, the left renal vein (LRV) could be easily identified at this site. The retroperitoneal tissue was dissected along the LRV, and the origin of the superior mesenteric artery (SMA) also was identified just above the LRV easily. The left adrenal gland was removed to secure the dorsal margin, if needed. The retroperitoneal dissection was continued along the major anatomical landmarks, including the LRV, the left renal artery, the left kidney, and the crus of the diaphragm beside the origin of the SMA. Using the same operative field, lymphadenectomy around the SMA was performed before dividing the pancreas. We could safely and easily expose the left aspect of the SMA after dissecting the ligament of Treitz. The dissection around the SMA was performed toward the side of the arterial root that had already been exposed above the LRV. Thus, the most important difficult steps of LDP for PC, such as retroperitoneal dissection and lymphadenectomy around the SMA, were safely performed early in the operation with a good laparoscopic view. Results The median operative time was 341 (range 288–354) minutes, and median blood loss was 150 (range 50–150) ml. An intraoperative transfusion was not required for any patient. Severe postoperative complications or mortality were absent. An R0 resection was achieved in all patients. Conclusions LDP using the “caudo-dorsal artery first approach” is safe and useful for performing a minimally invasive, curative resection for left-sided PC.

ASO Author Reflections: What Role Do Surgeons Play in the Era of Effective Systemic Therapy for Melanoma?