A Comparison of Laparoscopic Enucleation with Preoperative Selective Arterial Embolization (SAE) and Non-SAE for Renal Angiomyolipoma: A Meta-Analysis

Background: To compare the outcomes of laparoscopic enucleation with preoperative selective arterial embolization (SAE) and non-SAE for renal angiomyolipoma (RAML), we performed this systematic review and meta-analysis. Methods: We searched Web of Science, PubMed, EMBASE, the Cochrane Library, the Web of Science Core Collection, ClinicalTrials.gov, and China National Knowledge Infrastructure up to May 2019. Pooled relative ratio (RR) and standardized mean difference (SMD) with their 95% confidence intervals (CIs) were used to estimate the perioperative outcomes assessing the effectiveness and safety of laparoscopic enucleation with SAE and non-SAE.Results: A total of 4 studies were incorporated. The results showed that SAE group had a shorter operative time (SMD -2.15, 95% CI: -2.85 to -1.46, P < 0.001) , less blood loss (SMD -1.77, 95% CI: -2.06 to -1.47, P < 0.001), shorter warm ischemia time (SMD -2.57, 95% CI: -3.04 to -2.10, P < 0.001), and lower postoperative complication rate (RR 0.29, 95% CI: 0.08 to 0.98, P = 0.047), compared with the Non-SAE group. However, there was no significant difference in length of stay after operation (SMD -0.82, 95% CI: -3.26 to 1.63, P = 0.512), postoperative serum creatinine (SMD -0.59, 95% CI: -1.35 to 0.18, P =0.133), and GFR (SMD 0.59, 95% CI: -0.15 to 1.32, P =0.116) between the two groups. Sensitivity analysis showed that the results of our meta-analysis were robust, and deleting anyone study had no significant effect on the pooled results.Conclusions: Laparoscopic enucleation with preoperative SAE can shorten the operation time and warm ischemia time, decrease blood loss, preserve the renal function, and reduce the incidence of complications, which is a good option for the treatment of large RAMLs.

Unique position of a pancreatic head insulinoma during laparoscopic enucleation: case report

Insulinomas are benign pancreatic neuroendocrine tumors that require surgical intervention as a therapeutic measure. We describe an 18-year-old male patient who presented to the emergency department with a history of syncope, blurred vision, and diaphoresis. His blood sugar level was low upon admission, and a 72-hour fasting plasma glucose test showed low serum glucose, high serum insulin, and high C-peptide. An abdominal computed tomography scan and magnetic resonant imaging revealed a solitary tumor in the pancreatic head with no sign of ductal dilatation. Laparoscopic enucleation was performed, and a histopathological examination revealed findings consistent with insulinoma. The patient’s postoperative course was uneventful, and his follow-up examination was unremarkable. In conclusion, physicians should have a high clinical suspicion index for insulinomas, especially in young patients with a history of syncope, blurred vision, and diaphoresis, in order to avoid delayed diagnosis.

Short- and long-term outcomes of laparoscopic organ-sparing resection for pancreatic neuroendocrine neoplasms

Background Pancreatic neuroendocrine neoplasms (PNENs) are rare neoplasm with long life expectancy. In this setting, patients may benefit from laparoscopic organ-sparing resection. There are few reports of laparoscopic organ-sparing resection for PNENs. The aim of this study was to evaluate the Short- and long-term outcomes of laparoscopic organ-sparing resection for PNENs. Methods A retrospective study was performed for patients with PNENs who underwent laparoscopic organ-sparing pancreatectomy between March 2005 and May 2018. The patients’ demographic data, operative results, pathological reports, hospital courses, morbidity and mortality, and follow-up data (including pancreatic function, till August 2018) was analyzed. Results Thirty-five patients were identified. There were 9 male and 26 female patients, with a median age of 46 years (range, 25-75 years). The mean BMI was 24.6±3.3kg/m 2 . Nine patients received laparoscopic enucleation, 20 received laparoscopic spleen-preserving distal pancreatectomy, and 6 received laparoscopic central pancreatectomy. The operative time, intraoperative blood loss, transfusion rate, postoperative hospital stay were 186.4±60.2min, 165±73.0ml, 0, 9d(range, 5-23d), respectively. The morbidity rate, ≥Grade III complication rate and ≥grade B pancreatic fistula rate were 34.2%, 11.4%, 8.7%, respectively, with no mortality. The rate of follow-up was 94.3%, and the median follow-up time was 55 months (range, 3-158months). One patients had diabetes after laparoscopic spleen-preserving distal pancreatectomy, no patient had symptom of pancreatic exocrine insufficiency. One patient developed recurrence 36 months after laparoscopic enucleation and was managed with surgical resection. The other patients survived without metastases or recurrence during the follow-up. Conclusions Laparoscopic organ-sparing resection for selected cases of PNENs is safe and feasible, and have favorable short- and long-term outcome.