BACKGROUND:Interparietal inguinal hernia is an anatomically atypical subtype of groin hernia in which the hernia sac extends between layers of the abdominal wall rather than along the inguinal canal. Its true prevalence and optimal surgical management remain poorly defined in the era of routine cross-sectional imaging and laparoscopic repair. METHODS:We conducted a single-center retrospective study of patients undergoing surgical repair for groin hernia between April 2023 and March 2025. Preoperative diagnosis was based on computed tomography (CT) imaging, and interparietal hernia was confirmed intraoperatively. Patient characteristics, imaging findings, operative details, and short-term outcomes were analyzed. Incidence was assessed at both the patient and lesion levels. RESULTS:A total of 208 patients with 256 hernia lesions were included. Interparietal hernia was identified in 12 patients (5.8%) and 12 lesions (4.7%). Most patients were elderly women with low body mass index and presented with subtle or atypical groin symptoms. All cases suspected on preoperative CT were confirmed intraoperatively. A characteristic imaging feature was a hernia sac originating from the internal inguinal ring and extending cranially between abdominal wall layers. All interparietal hernias were successfully managed laparoscopically using the totally extraperitoneal approach, with no conversions, major complications, or need for bowel resection. CONCLUSION:Interparietal inguinal hernia may be more frequently identified in contemporary practice than previously reported, likely reflecting improved detection with CT imaging. Recognition of characteristic imaging findings is essential for accurate diagnosis and surgical planning. Laparoscopic repair, particularly the totally extraperitoneal approach, is a safe and effective treatment for this uncommon hernia subtype.
Background: Percutaneous radiofrequency ablation (RFA) is a widely accepted, minimally invasive treatment for hepatic tumors. However, it can rarely cause severe complications, including visceral and diaphragmatic perforation leading to acute empyema. Such complex scenarios, particularly in patients with underlying liver cirrhosis and malignancy, require a highly specialized management strategy. We report a successful treatment case utilizing a staged, multidisciplinary approach prioritizing source control. Case Description: A 76-year-old man with Child-Pugh B cirrhosis, previously treated for descending colon cancer and liver metastases, presented with fever and malaise 90 days after his third RFA session. Imaging revealed a right subphrenic abscess contiguous with the transverse colon and right pleural space, suggesting a delayed iatrogenic perforation caused by thermal injury. We diagnosed acute empyema secondary to pleuro-colonic communication. Given the severe infection and extensive adhesions, we executed a three-stage therapeutic strategy. Stage 1 involved thoracic infection control via drainage and thoracoscopic debridement. Stage 2 addressed the abdominal source; a diverting ileostomy was created to mitigate contamination, followed later by a right hemicolectomy and diaphragmatic repair using a Gerota's fascia patch. Stage 3 managed the residual refractory empyema and persistent air leak through an open window thoracostomy, followed by bronchial occlusion using endobronchial Watanabe spigots. The patient fully recovered, was discharged on day 162, and remains recurrence-free at the 15-month follow-up. Conclusions: Delayed colonic and diaphragmatic perforation is a rare but life-threatening complication of hepatic RFA. A rigorous staged, multidisciplinary approach focused on definitive source control and management of chronic pleural complications is essential for a favorable outcome in such complex cases.
383 Background: The optimal surgical approach for large type 3 and type 4 gastric cancers remains controversial. The objective of this study was to evaluate the safety and feasibility of minimally invasive surgery (MIS) such as laparoscopic and robotic approaches compared with open surgery for large type 3 and type 4 gastric cancer. Methods: This study included patients with large type 3 and type 4 gastric cancer who underwent open surgery or MIS between January 1, 2020, and December 31, 2022 at 63 high-volume centers in Japan. To compare the short-term outcomes and survival between the two approaches, inverse probability weighting (IPW) and stabilized average treatment effect weights based on each patient’s propensity score was applied. The following variables were included for propensity score estimation: age, sex, body mass index, American Society of Anesthesiologists physical status, clinical stage, preoperative chemotherapy, macroscopic type (large type 3/type 4), primary tumor location, tumor circumferential extent, esophageal invasion, splenic hilar dissection, and omentectomy. Results: A total of 1,013 patients who met the eligibility criteria were collected in this study. There were 505 patients with large type 3 gastric cancer and 508 patients with type 4 gastric cancer. Open surgery and MIS were performed in 653and 360 patients (laparoscopic surgery in 205 and robotic surgery in 155), respectively. Compared with open surgery, MIS resulted in a significantly longer operative time (334 vs. 282 min; P<0.001) and less intraoperative blood loss (29 vs. 304 ml; P<0.001). The postoperative hospital stay was significantly shorter in the MIS group compared with the open surgery group (11.0 vs. 13.0 days; P<0.001). After adjustment with IPW, the incidence of postoperative complications (Clavien–Dindo grade II or higher) was significantly lower in MIS compared with open surgery (9% vs. 16%; odds ratio 0.533, 95% CI 0.330–0.860; P=0.010). Although the median follow-up period was relatively was short (2.3 years), MIS showed outcomes comparable to open surgery, with OS (HR 0.888, 95% CI 0.690-1.144; P=0.358) and RFS (HR 0.834, 95% CI 0.678-1.032; P=0.095) after adjustment using IPW. Conclusions: MIS for large type 3 and 4 gastric cancers appears to be a safe and feasible approach, with short-term outcomes, suggesting non-inferiority to open surgery. However, long-term follow-up is necessary to confirm oncological efficacy.
The EXTREME regimen is the standard first-line treatment for recurrent or metastatic squamous cell carcinoma of the head and neck (R/M HNSCC), but it is poorly tolerated in Asian patients. We aimed to compare the efficacy and safety of the modified EXTREME (mEXTREME) and modified TPEx (mTPEx) regimens in Japanese patients. This was a multicenter, randomized, exploratory study. The dose of chemotherapeutic agents was reduced by 25
The presence of multiple Lugol-voiding lesions (LVLs) in the esophagus and pharynx is indicative of an increased risk for metachronous cancer. However, it is unclear whether esophageal LVLs can predict the development of head and neck squamous cell carcinoma (HNSCC). This retrospective observational study focused on patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma. Endoscopic images were categorized into three groups based on the number of unstained lesions in the pharyngeal mucosa: Group A had no lesions, Group B had 1 to 4 lesions, and Group C had 5 or more lesions per endoscopic view. Similarly, esophageal unstained lesions were classified into three groups based on the number of Lugol-unstained lesions: Group A had no lesions, Group B had 1 to 9 lesions, and Group C had 10 or more lesions. A total of 313 patients were included in the study. Among them, 157 patients (50.2
