ObjectiveTo investigate the effectiveness of modified kite flap in repair of soft tissue defect after divided nevus of lateral canthus excision.MethodsBetween October 2010 and April 2018, 20 children (20 eyes) with divided nevus of lateral canthus were admitted. There were 13 boys and 7 girls, with an average age of 7.9 years (mean, 4-14 years). There were 11 cases of moderate range lesions (maximum diameter, 1.5-2.0 cm) and 9 cases of small range lesions (maximum diameter, <1.5 cm). After excising the divided nevus of lateral canthus, the area of soft tissue defect ranged from 0.72 to 3.23 cm2. The modified kite flap was used to reconstruct the structure and shape of lateral canthus.ResultsThere were 16 cases of mixed nevus and 4 cases of intradermal nevus. The flaps survived and the incisions healed by the first intention. The patients were followed up 12-22 months (mean, 13.6 months). There was no malformation, valgus, exposure keratitis, or obvious scar. No malignant transformation occurred or nevus recurred during follow-up. At last follow-up, the effectiveness was rated as excellent in 16 cases, good in 3 cases, and poor in 1 case.ConclusionThe modified kite flap can repair the soft tissue defect after excising the divided nevus of lateral canthus, and obtain the good appearance and function of lateral canthus.
ObjectiveTo evaluate the short-term outcomes and hospital costs of robot-assisted thoracic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer. MethodsThe clinical data of patients who underwent lobectomy or sublobar resection for non-small cell lung cancer completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial Hospital from June 2016 to June 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a RATS group and a VATS group. The clinical data of the two groups were compared. ResultsA total of 516 patients were enrolled. There were 254 patients in the RATS group, including 103 males and 151 females, with a mean age of 60.0±4.2 years, and 262 patients in the VATS group, including 126 males and 136 females, with a mean age of 59.5±4.3 years. All patients in both groups successfully completed radical lung cancer surgery with no perioperative death. In terms of intraoperative bleeding (63.4±13.3 mL vs. 92.5±23.5 mL), postoperative drainage time (4.1±0.9 d vs. 4.7±1.2 d), postoperative hospital stay time (5.6±1.1 d vs. 6.7±1.4 d), number of lymph nodes dissected (17.9±2.1 vs. 13.9±1.4) and groups of lymph nodes dissected (5.4±0.8 groups vs. 4.4±1.0 groups), the RATS group had an advantage, and the difference was statistically significant (P<0.05). In terms of operative time and total postoperative chest drainage, the VATS group had an advantage, and the difference was statistically significant (P<0.05). There was no statistical difference between the two groups in terms of postoperative complications or intraoperative conversion to thoractomy (P>0.05). The total hospitalization, surgical and total consumables costs of the RATS group were higher than those in the VATS group (P<0.05). In terms of other costs and consumables costs (one-time costs of purely high-value consumables after deduction of robot-specific costs), the VATS group was higher than the RATS group (P<0.05). ConclusionRATS offers technical and short-term efficacy advantages, but comes with the disadvantage of high costs. Thoracic surgeons can make full use of the features of the robotic surgery system, exploiting its potential to continuously improve and optimize techniques and reduce the use of high-value consumables, thus achieving efficiency and cost reductions and allowing robotic surgery to reach more patients.
ObjectiveTo explore the effectiveness of modified rhomboid flap for repairing facial skin and soft tissue defect.MethodsBetween January 2016 and May 2018, 23 patients with facial skin and soft defect were repaired by the modified rhomboid flap. There were 10 males and 13 females with the median age of 27 years (range, 11-72 years). The primary tumor included pigmented nevus in 18 cases, basal cell carcinoma in 4 cases, and squamous cell carcinoma in 1 case. The defect location was nose in 8 cases, cheek in 4 cases, malar in 6 cases, forehead in 2 cases, and upper lip in 3 cases. The defect ranged from 0.8 cm×0.8 cm to 3.9 cm×3.9 cm. According to the location and size of facial tumors, the resection area of square lesions was designed. According to the mobility of surrounding tissues and the direction of dermatoglyphic lines, the rhomboid flaps with an angle of 45–60° was designed to repair the defect by tension-free rotation.ResultsAll the flaps survived and the incision healed by first intension. All patients were followed up 3-15 months (mean, 7.3 months). During follow-up, no tumor reoccurred; the color and texture of the flaps were similar with surrounding tissue. There was no obvious scar hyperplasia, nor traction of adjacent normal tissues, and patients were satisfied with the appearance.ConclusionThe application of modified rhomboid flaps in repairing facial skin and soft tissue defects caused by resection of round facial tumor has the advantages of flexible design, simple manipulation, and less trauma.
ObjectiveThe main objective of this study is to systematically evaluate the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction. MethodsThis study conducted a meta-analysis using Review Manager 5.4 software to compare the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang Data, and VIP were searched for relevant literature published through March 2023. ResultsThis study included a total of 23 articles, among which 16 were retrospective studies, 5 were prospective studies, and 2 were RCT. In total, 2826 patients, 1389 patients underwent proximal gastrectomy and 1437 patients underwent total gastrectomy. Meta-analysis showed that proximal gastrectomy had less intraoperative bleeding than total gastrectomy [MD=-19.85, 95% CI (-37.20, -2.51), P=0.02] and shorter postoperative hospital stay. Total gastrectomy had a higher number of lymph node dissections than proximal gastrectomy [MD=-6.20, 95% CI (-7.68, -4.71), P<0.00001] and a lower incidence of reflux esophagitis [MD=3.02, 95% CI (1.24, 7.34), P=0.01]. In contrast, there was no statistically significant difference between the two procedures in terms of operative time, postoperative OS (1-year OS, 3-year OS, 5-year OS) and total postoperative complications (P>0.05). ConclusionProximal gastrectomy had an advantage in terms of intraoperative bleeding and postoperative length of stay, whereas total gastrectomy had an advantage in terms of number of lymph nodes cleared and incidence of reflux esophagitis, with no significant difference in long-term survival between the two procedures.