Background: The development of laparoscopic and robotic surgeries represents the modern era with the objective of improving patient outcomes; this surgical method is widespread in urology and general surgery. Retroperitoneal laparoscopic/robotic surgery is common in urologic surgery, but not in liver surgery. Tumors located in the posterosuperior aspect of the liver are difficult to access using a transperitoneal approach, and control of bleeding can also be difficult, especially in patients with cirrhosis.Case Presentation: Herein, we present a 66-year-old man who had a cirrhotic liver with concurrent renal and hepatic tumors. The renal tumor was located at the upper pole of the right kidney and the liver tumor was located at the liver dome (segment VII); the patient underwent simultaneous robotic hepatectomy and partial nephrectomy with a retroperitoneal approach.Conclusion: To our knowledge, this is the first case involving a retroperitoneal approach for a simultaneous robotic hepatectomy and partial nephrectomy; this method was feasible and safe. We hope this approach serves as an alternative surgical method for patients with synchronous renal and posterior segment liver tumors.

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential. Inflammatory myofibroblastic tumor (IMT) of the alimentary tract often occurs in children or young adults, but may occur at any age. The lung is the most commonly affected location. However, it may appear in small bowel mesentery especially the distal ileum, mesotransverse colon, or greater omentum. A 35 years old female presented to out-patient department with complaint of mass in right abdomen since 1 month associated with loss of weight. Computed tomography of abdomen revealed a solid intraperitoneal mass arising from bowel mesentery. Laparoscopic excision of the tumor was performed and the histopathological examination of the mass revealed it to be an inflammatory myofibroblastic tumor arising from the omentum and large bowel mesentery. The post- operative period was uneventful with no evidence of tumor recurrence at follow up at 2 years. Inflammatory myofibroblastic tumor is a rare soft tissue tumor usually arising from lungs but tumor arising from the omental-mesenteric origin has also been documented. The precise diagnosis is made only by the histopathological evidence. Surgical resection is the treatment of choice.

Intrahepatic cholangiocarcinoma (IHCC) is the second most common malignant neoplasm of the liver. In spite of the increasing incidence worldwide, it is relatively rare in Western countries. IHCC is relatively common in Eastern and Southeastern Asia. Patients with IHCC are usually diagnosed at an advanced stage, therefore, the clinical outcome is dismal. Dysregulation of urea cycle metabolic enzyme expression is found in different types of cancers. Nevertheless, a comprehensive evaluation of genes related to the urea cycle (i.e., GO:0000050) has not been conducted in IHCC. By performing a comparative analysis of gene expression profiles, we specifically examined genes associated with the urea cycle (GO:0000050) in a publicly accessible transcriptomic dataset (GSE26566). Interestingly, CPS1 was identified as the second most prominently down-regulated gene in this context. Tumor tissues of 182 IHCC patients who underwent curative-intent hepatectomy were enrolled. The expression level of CPS1 protein in our IHCC cohort was assessed by immunohistochemical study. Subsequent to that, statistical analyses were carried out to examine the expression of CPS1 in relation to various clinicopathological factors, as well as to assess its impact on survival outcomes. We noticed that lower immunoreactivity of CPS1 in IHCC was associated with tumor progression (pT status) with statistical significance (p = 0.003). CPS1 underexpression was not only negatively correlated to overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS) and metastasis-free survival (MeFS) in univariate analysis but also an independent prognosticator to forecast poorer clinical outcome for all prognostic indices (OS, DFS, LRFS and MeFs) in patients with IHCC (all p ≤ 0.001). These results support that CPS1 may play a crucial role in IHCC oncogenesis and tumor progression and serve as a novel prognostic factor and a potential diagnostic and theranostic biomarker.