However, if the lesion size is >20 mm, this technique is not feasible and safe for an en bloc resection
owing to the size limitation of the snare (19-22).
The patient underwent en bloc resection
of the mass performed by a plastic surgeon, with preservation of the brachial plexus.
Caption: Figure 2: Intraoperative perspective after distal pancreatectomy with en bloc resection
of the celiac trunk as well as portal vein segment and successful reconstruction by interposition graft.
In the future, more therapeutic gastroenterologists in Canada may gain experience with ESD which allows for en bloc resection
of larger polyps and full histologic examination to exclude submucosal invasion.
Turner, "Intralesional excision compared with en bloc resection
for giant-cell tumors of bone," The Journal of Bone and Joint Surgery, vol.
Narita et al., "Extended surgery with en bloc resection
of the right common iliac vessels for lymph node metastasis of mucinous colon carcinoma: report of a case," Surgery Today, vol.
In 15 cases of recurrent GCT that we managed, five occurred in proximal tibia following curettage and bone cementing without any adjuvant, five occurred in distal femur following curettage and bone grafting without any adjuvant, one in proximal fibula following En bloc resection
, another in metacarpal bone following En bloc resection
and reconstruction with fibular graft and three in distal radius following curettage and bone grafting.
Patient #4 developed locoregional recurrence invading an ileal segment and underwent en bloc resection
38 months after RC and PD.
A25 x 18 x 10 mm superficial lesion was removed by en bloc resection
There were no significant differences in submucosal injection frequency, specimen size, en bloc resection
rate and perforation rate between the two endoscopic groups.
In our case, the en bloc resection
nature of the ribs and sternum was deemed unsuitable for reconstruction by the operating surgeon and, due to financial constraints, no further attempts were made for reconstruction.
Surgical intervention either by placing drains or en bloc resection
appears to have greatest success (Veenendaal et al., 1981).