H aving a common language including well-defined terms and adherence to certain policies and procedures in the management of patients with thymic malignancies is necessary to facilitate progress. This is especially true for minimally invasive resections. Different technical approaches have been used, 1,2 and a careful examination of results is needed to understand the impact of the minimally invasive approach itself, as opposed to other factors. For example, during an open approach, most surgeons perform a complete en bloc resection of the tumor and a complete thymectomy with removal of the upper cervical poles and the surrounding mediastinal fat 3 ; whether this is done during minimally invasive resections is hard to decipher at present. This article identifies key aspects that should be reported, common definitions that should be adopted and proposes certain standard policies that should be adhered to when performing a minimally invasive resection of a thymic malignancy. These definitions and policies do not apply to biopsies. These policies are not meant to stifle innovation; on the contrary, they should facilitate progress by providing a framework, so that experiences and outcomes can be compared and analyzed more clearly. These standards have been adopted by members of the International Thymic Malignancy Interest Group (ITMIG), which is a worldwide collaborative organization of individuals interested in mediastinal tumors.

Minimally invasive surgery for rectal cancer proved to be safe and efficient with similar results in the two groups. Technological advances of robotic approach compared to laparoscopy allowed better ergonomics, more refined dissection, easier preserving of hypogastric nerves and less blood loss. Long term outcomes are to be assessed in prospective randomized studies.

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Background/aimsNeuroendocrine tumours occur very rarely in the ampulla of Vater and their clinical behaviour is unknown. The aim of this study is to assess the clinico-pathological features, surgical approach and prognosis of these patients.MethodsSix patients with neuroendocrine tumours of the ampulla of Vater treated with curative intent surgery at a single centre were retrospectively analysed. A univariate analysis of potential prognostic factors was also performed (data provided from the present study and literature review).ResultsPancreaticoduodenectomy was curative in all the patients. Overall and disease-free survival rates were significantly better for G1/G2 tumours (p = 0.006 and p = 0.004, respectively). Although frequent, lymph node metastases did not influenced both overall (p = 0.760) and disease-free survival rates (p = 0.745). No significant differences of survival were observed in patients with ENETS stage I/II disease, as compared to ENETS stage III disease (p = 0.169 and p = 0.137, respectively). No differences were observed according to UICC staging system (p = 0.073 and p = 0.177, respectively). Tumours that are less than 2 cm or limited to the ampulla appear to have a better prognosis.ConclusionThe WHO 2010 classification appear to accurately predict patient prognosis, while the ENETS or UICC staging systems have a limited value (especially in regard to lymph node metastases). Radical surgery (i.e. pancreaticoduodenectomy with lymphadenectomy) should be the standard approach in most patients with NET of the ampulla of Vater because this procedure removes all the potential tumour-bearing tissue.

Integration of instructional media with telementoring can be as effective for the development of surgical skills as local mentoring.