A laparoscopic approach to gastrointestinal stromal tumors (GISTs) of the small bowel seems to be a safe method even in the face of emergent surgery when open oncologic principles of bowel and tumor handling are followed.

Background: Differentiated thyroid cancer (DTC) is comprised of papillary and follicular subtypes, and both have an overall excellent long-term prognosis. Patients with localized DTC that is successfully treated, usually with surgery, exhibit long-term survival well above 90%. In contrast, patients who develop distant metastatic disease have a significantly worse overall prognosis and outcome, often with disease that is refractory to conventional therapy such as surgery, radioactive iodine, and hormone suppression. For patients who recur with distant metastatic disease, limited effective treatment options are available, and most die of their disease within 5 years of recurrence. Case Report: We report the case of a 26-year-old female who presented with recurrent papillary thyroid cancer and a metastatic lesion isolated to the liver. Because of the extremely large size of the metastatic liver mass upon initial presentation, we took a neoadjuvant, multifaceted approach to treatment that included selective internal radioembolization therapy, an oral multikinase inhibitor, and surgical resection of the tumor mass after maximal reduction in tumor size. However, the patient died of metastatic DTC after 39 months of treatment. Conclusion: A multimodal, comprehensive approach to managing such complex patients is essential to optimize both the sequence and therapeutic approach to treatment.

Background: Loss of domain, fascial separation, and wound contamination are all recognized challenges of complex abdominal wall reconstruction. Often, traditional therapies, such as fascial advancement, mesh reinforcement, and the use of bio-prostheses for infection are insufficient. Recently, we have investigated using cutis as an alternative therapy. We present the case of a 61-year old male treated in such a manner. Methods: Our patient presented to our facility with a fascial defect of 30 by 40 cm, and an infected skin graft after undergoing an exploratory laparotomy for a gunshot wound at an outside hospital. During his course, he failed multiple traditional therapies, leaving him with a large open wound, four paired enterocutaneous fistulae, and a cholecystocutaneous fistula. We repaired his fistulae, performed a staged fascial closure, and reinforced it by placing an autograft of de-epithelialized dermis over it, bridging some areas of fascia. Results: The patient had rapid incorporation of his cutis graft, with granulation over the graft within 72 hours. Within three months, all wounds had healed, and the patient had fully recovered. Conclusions: Cutis autograft as a means for reinforcing abdominal wall closure is a versatile tool in the armamentarium of the surgeon to treat complex abdominal wall reconstruction. In the setting of failure of traditional therapies for fascial closure, it can potentially help with simultaneous bridging and reinforcement, demonstrating the strength of this type of repair

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