Background: The Endoscopic Surgical Skill Qualification System (ESSQS) was introduced in Japan to improve the quality of laparoscopic surgery. This cohort study investigated the short-and long-term postoperative outcomes of colorectal cancer laparoscopic procedures performed by or with qualified surgeons compared with outcomes for unqualified surgeons.Methods: All laparoscopic colorectal resections performed from 2010 to 2013 in 11 Japanese hospitals were reviewed retrospectively. The procedures were categorized as performed by surgeons with or without the ESSQS qualification and patients' clinical, pathological and surgical features were used to match subgroups using propensity scoring. Outcome measures included postoperative and long-term results.Results: Overall, 1428 procedures were analysed; 586 procedures were performed with ESSQS-qualified surgeons and 842 were done by ESSQS-unqualified surgeons. Upon matching, two cohorts of 426 patients were selected for comparison of short-term results. A prevalence of rectal resection (50⋅3 versus 40⋅5 per cent; P < 0⋅001) and shorter duration of surgery (230 versus 238 min; P = 0⋅045) was reported for the ESSQS group. Intraoperative and postoperative complication and reoperation rates were significantly lower in the ESSQS group than in the non-ESSQS group (1⋅2 versus 3⋅6 per cent, P = 0⋅014; 4⋅6 versus 7⋅5 per cent, P = 0⋅025; 1⋅9 versus 3⋅9 per cent, P = 0⋅023, respectively). These findings were confirmed after propensity score matching. Cox regression analysis found that non-attendance of ESSQS-qualified surgeons (hazard ratio 12⋅30, 95 per cent c.i. 1⋅28 to 119⋅10; P = 0⋅038) was independently associated with local recurrence in patients with stage II disease.Conclusion: Laparoscopic colorectal procedures performed with ESSQS-qualified surgeons showed improved postoperative results. Further studies are needed to investigate the impact of the qualification on long-term oncological outcomes.

Background Hepatic cavernous hemangioma (CH) is the most common hepatic benign tumor. Most cases are solitary, asymptomatic, and found incidentally. In symptomatic cases with rapidly growing tumors and coagulopathy, surgical treatment is considered. In rare cases, diffuse hepatic hemangiomatosis (DHH) is reported as a comorbidity. The etiology of DHH is unknown. Case presentation A 29-year-old female patient had a history of endometriosis treated with oral contraceptives. Hepatic CH was incidentally detected in the segment IVa of the liver according to the Couinaud classification. Follow-up computed tomography (CT) and ultrasound sonography showed the growth of the lesion and formation of multiple new lesions near the first. Enhanced CT and magnetic resonance imaging (MRI) revealed that the new lesions were different from CH. Although oral contraceptives were stopped, all lesions grew in size. Malignancy and possibility of rupture of these tumors were considered due to the clinical course, and we opted for surgical removal of the tumors. Left liver lobectomy and cholecystectomy were performed. Surgical findings were small red spot spreading and a mass in segment IV of the liver. Pathological examination revealed a circumscribed sponge-like tumor with diffuse irregular extension to the adjacent area. Both of the lesions consisted of blood-filled dilated vascular spaces lined by flat endothelium without atypia. The diagnosis was hepatic CH with DHH. The patient was discharged on postoperative day 12 uneventfully. Conclusion We report the successful resection of CH with DHH. The case findings suggest a relationship between oral contraceptive use and enlargement of CH and DHH. Although DHH has been poorly understood, a few previously published cases reported DHH occurrence in patients using oral contraceptives. In such cases, the decision to perform surgical resection should be made after careful examination.

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We report a case of primary malignant melanoma of the esophagus (PMME). A 67-year-old man was referred to our hospital because of dysphagia. Upper gastrointestinal endoscopy revealed a polyploid tumor in the lower thoracic esophagus. Biopsy specimens revealed large atypical cells containing brown granules, and immunohistochemical staining was positive for HMB-45. Pigmented lesions of the skin, rectum, or eyes were not observed, and we diagnosed the tumor as PMME. A subtotal esophagectomy via right thoracotomy and laparotomy was performed. Histopathological examination showed lymph node metastasis and tumor cell invasion to the submucosal layer (T1b). According to the Japanese classification of Esophageal cancer, the pathological stage was stage Ⅱ T1bN1M0. Adjuvant chemotherapy was not performed because of postoperative complications. Fourteen months after the operation, the tumor relapsed in the lung, liver, and retroperitoneum. Chemotherapy was administered, but the patient died of tumor recurrence 20 months after the operation. The prognosis of PMME is poor, as is that for cases of submucosal invasion. Investigation of the long-term prognosis and efficacy of progressive immunochemotherapy are very important to improve the prognosis of PMME.