Purpose: To evaluate the tolerance of a low dose chemotherapy regimen for desmoid tumours. Patients and methods: Patients with desmoids for whom radical resection was impossible or related to extensive mutilation were treated with chemotherapy. Treatment consisted of intravenous methotrexate at a dose of 50 mg and vinblastine at a dose of 10 mg weekly, scheduled to be given for a total period of 1 year. Doses were reduced and/or delayed on an individual basis, depending on the observed type of toxicity. Results: Ten patients (six males; four females), median age 43 years (range17-75), median WHO performance score 1 (range 0-1), were treated. None of them was able to complete the treatment as scheduled, due to observed side effects, while in two patients treatment was also discontinued because of progressive disease. In six patients, less than 50% of the projected administrations and dose could be given. Severe organ toxicity was noted in three patients (one interstitial pneumonitis, two toxic hepatitis), which, however, was reversible in all cases. Discussion: Methotrexate and vinblastine given at this dose and schedule lead to an unacceptable level of toxicity for a long-term treatment, and cannot be recommended for standard use.

In urology the introduction of extracorporeal shockwave therapy brought a revolutionary change to the management of urinary calculi. This inspired the introduction of shockwave therapy in several fields of surgery; it has been applied as a potential alternative to several operative procedures but is still experimental. So far, the major application of shockwave therapy has been lithotripsy of stones in the gallbladder, common bile duct, pancreatic duct and salivary gland ducts. Other applications are in the non-operative management of bone healing disturbances and in the inhibition of tumour growth. Steps towards selective thrombus ablation and pretreatment of heavily calcified arteries have also been made. In this review, the applications of extracorporeal shockwave therapy in several areas of surgery are discussed. It is concluded that, for selected patients, shockwave treatment may serve as a useful addition to the surgical armamentarium.

We prospectively studied the course of quality of life and gastrointestinal and biliary symptoms after laparoscopic (n = 14) and conventional cholecystectomy (n = 17). It was found that cholecystectomy significantly improved quality of life and cured nausea, fatty food upset, stomach swelling and biliary pain. It was also found that laparoscopic cholecystectomy improved quality of life and symptomatology at an earlier stage than conventional cholecystectomy. Therefore, more circumstantial evidence is provided that laparoscopic cholecystectomy is superior to conventional cholecystectomy.

No abstract

Background Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. Methods Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either ‘node-picking’ (the removal of an individual LLN) or ‘partial regional node dissection’ (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those  undergoing only rectal resection. Results Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7–3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2–2.5, p = 0.874). Conclusion Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.