Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.
Objective To investigate the method and effectiveness of wide local excision combined with Mohs micrographic surgery for dermatofibrosarcoma protuberans (DFSP). Methods Between January 2007 and January 2010, 17 patients with DFSP were treated. There were 9 males and 8 females with an average age of 33.2 years (range, 16-55 years). Thelesions were located at head and neck (2 cases), trunk (12 cases), extremity (2 cases), and perineal region (1 case). There were 6 cases of primary DFSP and 11 cases of relapsed DFSP. The lesions presented as single or multitude nodules or fusion nodules with skin withering, scar, en plaque in the center and with ill-defined margins. The diameter of lesions ranged from 0.8 to 9.7 cm (mean, 4.3 cm). No distant metastasis or lymphatic metastasis occurred in all cases. After tumors resection by wide local excision combined with Mohs micrographic surgery, the wounds were repaired by direct suture in 3 patients, skin grafting in 9 patients, and local skin flap in 5 patients. Results Wide local excision and Mohs micrographic surgery were carried out once in 13 patients, twice in 3 patients, and three times in 1 patient with an average operation time of 98.6 minutes (range, 56-219 minutes). Primary heal ing of wound and donor site were achieved with no necrosis of skin grafting and skin flap. All patients were followed up 8-34 months (mean, 21.7 months) with no recurrence. Conclusion Wide local excision combined with Mohs micrographic surgery could treat DFSP, which has the advantages of shorter operation time, radical resection, and less injury.
Rectal tumor surgery is currently at a critical stage of transformation from “organ resection” to “precision intervention”. Total mesorectal excision has significantly improved the local control of rectal cancer; however, defecatory, urinary, and sexual dysfunction, as well as low anterior resection syndrome after radical surgery, still profoundly affect patients’ long-term quality of life. With the development of early screening, precision imaging, total neoadjuvant therapy, immunotherapy, and organ preservation concepts, an increasing number of rectal lesions exhibit the characteristics of “being amenable to local intervention, requiring functional protection, and yet not compromising oncological safety”. Based on previous literature reports and our team’s practice, this article proposes the concept of a transanal minimally invasive surgery system: utilizing the transanal approach as a common pathway, and based on whether it relies on a transanal endoscopic platform, whether it involves direct-vision intersphincteric operation, and whether it requires extended mesorectal excision and reconstruction, the related procedures are classified into transanal minimally invasive surgery under transanal endoscopy, transanal intersphincteric resection, extended transanal minimally invasive surgery formed by combining the two, and transanal partial mesorectal excision. This system helps to integrate endoscopic therapy, transanal endoscopic local excision, direct-vision transanal intersphincteric resection, robot-assisted transanal surgery, and complex luminal reconstruction into the same decision-making framework, thereby more clearly defining the resection depth, operational boundaries, and reconstruction strategies for different lesions. Simultaneously, this article fully incorporates the concept of integrated minimally invasive approaches, interpreting transanal minimally invasive surgery as a multidimensional injury control and response-guided decision-making tool, rather than simply comparing incision size or the superiority and inferiority of technical platforms. Herein, the value of local excision can be summarized as resecting suspicious residual lesions under limited trauma and obtaining complete pathological information, thereby accomplishing risk re-stratification within the organ preservation strategy. On this basis, this article further emphasizes that local excision should not be positioned merely as a passive salvage option after neoadjuvant therapy or as a substitute for the watch-and-wait strategy following clinical complete response/near complete response. Instead, it can be shifted forward into the comprehensive treatment decision-making chain to become a key node for efficacy verification, pathological re-stratification, and determining whether to proceed with radical surgery; meanwhile, classic radical surgery should serve as the ultimate curative measure for situations such as high pathological risk, insufficient treatment response, local regrowth, and failure of salvage pathways after local excision.