Near-infrared laparoscopic fluorescence for pelvic side wall delta mapping in patients with rectal cancer--'PINPOINT' nodal assessment

Low rectal cancers metastase lymphatically to the pelvic side wall in addition to cephalad spread alongside the superior rectal/inferior mesenteric arterial axis. Radical surgery in the West has focused resectional intent and effort on the midline en bloc oncological package by Total Mesorectal Excision. While neoadjuvant chemo/radiotherapy (now often administered to patients with radiologically locally advanced cancer) may contribute significant therapeutic effect to the lateral pelvic side walls, many patients with earlier preoperative stage low rectal cancer are offered surgery first (and indeed solely). Furthermore, some of those pretreated may have residual in situ lateral nodal disease and so risk understaging and undertreatment. Routine extended lymphadenectomy is on the other hand unproven with respect to survival benefit and has likely no added role in the absence of definite (rather than possible) side-wall involvement. Near-infrared fluorescence pelvic side-wall delta mapping, as illustrated here in five patients undergoing abdominoperineal resection for rectal cancer after neoadjuvant therapy, may give the technological capacity to identify tumor site-draining nodes on the pelvic side and the focus the operating surgeon on this potential target for surgical resection (whether by berry picking or nerve sparing clearance) and prompt individualized diagnostic and therapeutic selection.

Pseudomyxoma peritonei originating from urachus-case report and review of the literature

Pseudomyxoma peritonei (pmp) is a rare clinical condition defined as extensive intraperitoneal spread of mucus associated with a variety of mucinous tumours of varying biologic behavior. Although appendix or ovaries have usually been implicated as the primary site, cases have been reported in association with neoplastic lesions of other sites. Pseudomyxoma peritonei originating from urachal remnants is a unique entity, reported only 18 times in the English literature thus far. Considering the rarity of the lesion, we report the case of a 50-year-old man surgically treated for pmp associated with a low-grade mucinous urachal neoplasm. Unique aspects of case are the low histologic aggressiveness of the causative lesion (reported only twice worldwide) and the early stage of the disease, with a relatively small amount of intraperitoneal free mucin. Review of the literature about pmp in general and a collation of previously reported cases of pmp originating from the urachus are presented and discussed.