No abstract

Benign cystic mesothelioma is a very rare and uncommon lesion, first reported by Plaut in 1928. It affects young women of reproductive age. It is usually asymptomatic or has non-specific symptoms. Diagnosis remains difficult despite the evolution of imaging, and the histopathological study is the key examination to make the diagnosis. Surgery remains the only curative treatment, regardless of significant rate of recurrence, and until today, no consensus on the therapeutic strategy is established.

Objective: This study aimed to analyse the learning curve (LC) in laparoscopic rectal cancer resections of 2 millennial surgeons during the implementation of the first laparoscopic rectal cancer surgery programme in low- and middle-income country (LMIC) cancer centre. Methods: All consecutive patients operated by two millennial surgeons for primary rectal adenocarcinoma between January 2018 and March 2020 were included. The LC was analysed for operative duration and conversion to open surgery using both cumulative sum (CUSUM) and/or variable life-adjusted display (VLAD) charts. Results: Eighty-four patients were included, 45 (53.6%) men with a mean age of 57.3 years. Abdominoperineal resection was performed in 31 (36.9%) cases and resections were extended to other organs in 20 (23.8%) patients. Thirteen patients (15.5%) had conversion to open surgery. Using CUSUM, Learning curve based on conversion was completed at 12 cases for the first surgeon versus 10 cases for the second. While using VLAD and learning curve-CUSUM (LC-CUSUM), the cases needed were 26 vs 24 respectively. The median operative duration was 314 min with a LC completed at cases (17 vs. 26), and (18 vs. 29) using, respectively, standard and LC-CUSUM. Conclusions: This study shows a safe and short LC of millennial surgeons during the implementation of a laparoscopic rectal cancer surgery in an LMIC cancer centre, and the valuable use of modern statistical methods in the prospective assessment of LC safety during surgical training.

The combination of gastric tumor and hiatal hernia is a rare event, that makes management delicate, and the prognosis pejorative given the risk of multidirectional lymphatic dissemination. Through this case report, we present a fully laparoscopic management, in an 80-year-old woman with a gastric tumor of the upper 1⁄3 of the stomach, associated with a huge hiatal hernia. This lady presented to the emergencies during the period of the Covid 19 pandemic, for dyspnea crisis of progressive worsening. thoraco-abdominopelvic CT showed a huge hiatal hernia explaining its symptomatology. Esogastroduodenal fibroscopy showed a cardia-gastric tumor. A total laparoscopy gastrectomy with lymph node dissection D1.5 associated with a cure of hiatal hernia were performed. The postoperative follow-up was simple and the patient declared outgoing on Day 5 postoperative.