Background Malignant ovarian germ cell tumors (MOGCTs) are rare and represent 1–1.5% of all cancers in children and adolescents. The aim of this study is to analyze the clinicopathological pattern at presentation and management and outcome of MOGCTs in children and adolescents. Patients and methods Retrospective study included all girls diagnosed with MOGCTs between January 2005 and January 2015 in Pediatric and Surgical Oncology Departments at South Egypt Cancer Institute, Assiut University. Data were collected from patients' records including initial presentation, diagnosis (tumor markers and imaging), surgical staging and pathologic types. Management (surgical and chemotherapy details) and outcomes were also analyzed. Results Forty girls aged between 4 to 17 years (mean age of 9.5 years) with diagnosis of MOGCTs during study period were included. The most common presenting symptoms and signs were abdominal swelling, abdominal pain, and pelvic mass. Precocious puberty was noted in two patients. Surgical interventions in most patients were unilateral salpingo-oophorectomy (n = 20). Early stages I and II were reported in 15 and 12 patients respectively, while 10 patients had stage-III disease and 3 patients had stage IV. Yolk sac tumors were reported in 27.5% of patients. All patients were treated with platinum based chemotherapy. The 7-year overall survival was higher for patients with early stages (I and II) compared with advanced stages (III and IV) (100% versus 30.8% respectively. Conclusions Early presentation with appropriate management using fertility sparing surgery and platinum-based chemotherapy provides excellent survival with fertility preservation in children and adolescents. Based on the lower survival of patients with advanced disease, efforts should focus on increasing the awareness in the community of the importance of early diagnosis of ovarian tumors.

Background The feasibility of a laparoscopic approach in patients who have had a prior laparotomy (PL) remains controversial. We hypothesized that laparoscopic colorectal resection was safe and feasible in patients with previous open abdominal surgery. Methods A retrospective review (2007–2015) of all patients undergoing laparoscopic resection for sigmoid and rectal adenocarcinoma with or without prior midline laparotomy (NPL) was performed. Primary endpoints included conversion and perioperative morbidity. Secondary endpoints included length of stay and perioperative outcomes. Demographics, surgical history, oncologic staging, and short-term outcomes were reviewed. Results We identified 211 patients, ofwhom33 (15.6%) had a prior laparotomy. Significantly more patients in the PL group were female (76.2 vs. 52.8%, p = 0.004). Patients with PL were of similar age to NPL patients (69.3 vs. 62.5, p = 0.09), and comorbidities, tumor staging, and neoadjuvant therapy were comparable between groups (all p > 0.05). Additional trocar placement was significantly higher in PL group (33.3 vs. 17.4%, p = 0.03), while conversion rate did not reach statistical significance (24.2 vs. 12.9%, p = 0.08). The postoperative complication rate was comparable between PL and NPL patients (33.3 vs. 25.3%, respectively, p = 0.2). Conclusions Prior laparotomy should not be a contraindication to patients undergoing laparoscopic colorectal surgery, though surgeons should anticipate a higher likelihood of conversion to open.

Background The feasibility of a laparoscopic approach in patients who have had a prior laparotomy (PL) remains controversial. We hypothesized that laparoscopic colorectal resection was safe and feasible in patients with previous open abdominal surgery. Methods A retrospective review (2007–2015) of all patients undergoing laparoscopic resection for sigmoid and rectal adenocarcinoma with or without prior midline laparotomy (NPL) was performed. Primary endpoints included conversion and perioperative morbidity. Secondary endpoints included length of stay and perioperative outcomes. Demographics, surgical history, oncologic staging, and short-term outcomes were reviewed. Results We identified 211 patients, ofwhom33 (15.6%) had a prior laparotomy. Significantly more patients in the PL group were female (76.2 vs. 52.8%, p = 0.004). Patients with PL were of similar age to NPL patients (69.3 vs. 62.5, p = 0.09), and comorbidities, tumor staging, and neoadjuvant therapy were comparable between groups (all p > 0.05). Additional trocar placement was significantly higher in PL group (33.3 vs. 17.4%, p = 0.03), while conversion rate did not reach statistical significance (24.2 vs. 12.9%, p = 0.08). The postoperative complication rate was comparable between PL and NPL patients (33.3 vs. 25.3%, respectively, p = 0.2). Conclusions Prior laparotomy should not be a contraindication to patients undergoing laparoscopic colorectal surgery, though surgeons should anticipate a higher likelihood of conversion to open.

Background and Objectives: Vulvar cancer is a rare tumor accounts for approximately 3-5% of all gynaecological ma-lignancies and 1% of all cancers in women, with incidence rate of 1-2/100,000. Typically these cancers occur in the seventh decade when comorbidity is common. The most prominent presenting symptom of vulvar cancer is localized pruritus. Vulvar cancer surgical treatment may has a number of short and long term complications. In our series which include twenty five patients; we will discuss the most common com-plications and how to avoid and treat them. In this series we will review our most common compli-cations after surgical treatment of cancer vulva and how to avoid and treat them specially in the inguinal region. Patient and Methodes: This is retrospective study was conducted in Surgical Oncology Department, South Egypt cancer institute, Assiut University, from 2011-2014. Twenty five patients with proved vulvar cancer to whom surgical treatment was performed were included in our study and their data were retrospectively collected. Result: All patients in our series have squamous cell carcinoma as it is the commonest neoplasm that affects vulva. There is no operative related mortality. All complications are estimated per patient. Patients and tumor characteristics are reviewed. There are only significant difference in seroma formation (15.4% vs 66.7% respectively) p-value 0.01 and lymphedema (23.1% vs 75% respectively) p-value0.01. And there is significant difference in the incidence of wound breakdown (58.3% vs 15.4% respectively) p-value 0.05. Conclusion: Inguino-femoral dissection is an important step in surgical treatment of vulvar cancer but has many post-operative complications as wound dehiscence, seroma, cellulitis and lympedma which affect patient socio-psychological state and increase hospital stay.

Background and Objectives: Vulvar cancer is a rare tumor accounts for approximately 3-5% of all gynaecological ma-lignancies and 1% of all cancers in women, with incidence rate of 1-2/100,000. Typically these cancers occur in the seventh decade when comorbidity is common. The most prominent presenting symptom of vulvar cancer is localized pruritus. Vulvar cancer surgical treatment may has a number of short and long term complications. In our series which include twenty five patients; we will discuss the most common com-plications and how to avoid and treat them. In this series we will review our most common compli-cations after surgical treatment of cancer vulva and how to avoid and treat them specially in the inguinal region. Patient and Methodes: This is retrospective study was conducted in Surgical Oncology Department, South Egypt cancer institute, Assiut University, from 2011-2014. Twenty five patients with proved vulvar cancer to whom surgical treatment was performed were included in our study and their data were retrospectively collected. Result: All patients in our series have squamous cell carcinoma as it is the commonest neoplasm that affects vulva. There is no operative related mortality. All complications are estimated per patient. Patients and tumor characteristics are reviewed. There are only significant difference in seroma formation (15.4% vs 66.7% respectively) p-value 0.01 and lymphedema (23.1% vs 75% respectively) p-value0.01. And there is significant difference in the incidence of wound breakdown (58.3% vs 15.4% respectively) p-value 0.05. Conclusion: Inguino-femoral dissection is an important step in surgical treatment of vulvar cancer but has many post-operative complications as wound dehiscence, seroma, cellulitis and lympedma which affect patient socio-psychological state and increase hospital stay.

Background:Laparoscopic surgery with a small laparotomy reportedly has several advantages over conventional open surgery, including less invasiveness, less pain, earlier recovery,and bettercosmoses. Theaimofthis study was tocomparetechnicalfeasibilityand early clinical outcomes of laparoscopic-assis'cd and open radical gastrectomy for gastric cancer. Patients and methods:ln our prospective study, patients with distal gastric cancer were divided the patients in two groups (a) patients underwent radical gastrectomy by LADG (21 patients)and(b) aDG (21 patients).Forthepostoperativepathologicresults,the tumor-nodalmetastasis (1NM) stage, grade of tumor differentiation, distal and proximal margins, the number of harvested lymph nodes were evaluated.Staging was done according to the 7th edition of the UICC tumor, node, and metastasis (TNM) classification. 0 Iand D2 lymphadenectomy with curative RO intention was attempted in all cases.Operative mortality and morbidity were assessed. Results: The time to initiate oral intake, and postoperative hospital stay were significantly shorter in the LADG group than ill the ODG group (P 0.05).There no significant difference between the operative time in the LADG group and the aDO group (P = 0.6), whereas blood loss and blood infusion frequency were significantly lower (P O.OOOt) in the LADG group in comparison to ODG group. Conclusion:Laparoscopic-assisted distal gastrectomy for distal gastric cancer is a safe and feasible technique alternative to open gastrectomy, with at least similar short term oncologic results. However, laparoscopic gastric surgery is in need to Adequate training and technical support especially in D2 lymphadenectomy.

Background:Laparoscopic surgery with a small laparotomy reportedly has several advantages over conventional open surgery, including less invasiveness, less pain, earlier recovery,and bettercosmoses. Theaimofthis study was tocomparetechnicalfeasibilityand early clinical outcomes of laparoscopic-assis'cd and open radical gastrectomy for gastric cancer. Patients and methods:ln our prospective study, patients with distal gastric cancer were divided the patients in two groups (a) patients underwent radical gastrectomy by LADG (21 patients)and(b) aDG (21 patients).Forthepostoperativepathologicresults,the tumor-nodalmetastasis (1NM) stage, grade of tumor differentiation, distal and proximal margins, the number of harvested lymph nodes were evaluated.Staging was done according to the 7th edition of the UICC tumor, node, and metastasis (TNM) classification. 0 Iand D2 lymphadenectomy with curative RO intention was attempted in all cases.Operative mortality and morbidity were assessed. Results: The time to initiate oral intake, and postoperative hospital stay were significantly shorter in the LADG group than ill the ODG group (P 0.05).There no significant difference between the operative time in the LADG group and the aDO group (P = 0.6), whereas blood loss and blood infusion frequency were significantly lower (P O.OOOt) in the LADG group in comparison to ODG group. Conclusion:Laparoscopic-assisted distal gastrectomy for distal gastric cancer is a safe and feasible technique alternative to open gastrectomy, with at least similar short term oncologic results. However, laparoscopic gastric surgery is in need to Adequate training and technical support especially in D2 lymphadenectomy.

Background:Laparoscopic surgery with a small laparotomy reportedly has several advantages over conventional open surgery, including less invasiveness, less pain, earlier recovery,and bettercosmoses. Theaimofthis study was tocomparetechnicalfeasibilityand early clinical outcomes of laparoscopic-assis'cd and open radical gastrectomy for gastric cancer. Patients and methods:ln our prospective study, patients with distal gastric cancer were divided the patients in two groups (a) patients underwent radical gastrectomy by LADG (21 patients)and(b) aDG (21 patients).Forthepostoperativepathologicresults,the tumor-nodalmetastasis (1NM) stage, grade of tumor differentiation, distal and proximal margins, the number of harvested lymph nodes were evaluated.Staging was done according to the 7th edition of the UICC tumor, node, and metastasis (TNM) classification. 0 Iand D2 lymphadenectomy with curative RO intention was attempted in all cases.Operative mortality and morbidity were assessed. Results: The time to initiate oral intake, and postoperative hospital stay were significantly shorter in the LADG group than ill the ODG group (P 0.05).There no significant difference between the operative time in the LADG group and the aDO group (P = 0.6), whereas blood loss and blood infusion frequency were significantly lower (P O.OOOt) in the LADG group in comparison to ODG group. Conclusion:Laparoscopic-assisted distal gastrectomy for distal gastric cancer is a safe and feasible technique alternative to open gastrectomy, with at least similar short term oncologic results. However, laparoscopic gastric surgery is in need to Adequate training and technical support especially in D2 lymphadenectomy.

Background: Breast-conserving surgery plus radiotherapy is firmly established as a good and safe option for most women with early breast cancer. Cosmoses after Breast-conserving surgery depend on two main factors; the site of the lesion and the breast volume excised in relation to total breast volume. Latissimus dorsi miniflap is one of the various autologous tissue reconstructions that can replenishe loss of more than 25% of breast volume. The aim of our study is to evaluate the aesthetic outcome and complications of breast reconstruc-tion using latissimus dorsi miniflap augmentation after wide local excision of the tumor combined with axillary lymph node dissection. Patients and Methods: The study involved twenty eight patients with breast cancer underwent conservative breast surgery in the form of wide local excision with safety margin with immediate reconstruction using Latissimus dorsi miniflap either by muscle only or musculocutaneous flap. Neoadjuvant chemotherapy was given in some cases to reduce the tumor size and after surgery; all cases received eligible adjuvant therapy. Results: Most of the patients (71.4%) were having T2 tumor, while (14.3%) of the patients had T1 tumor and (14.3%) had T3 tumor. Neoadjuvant chemotherapy was given for 14 patients with overall response rate about 76.7%. Wide local excision with safety margin with immediate reconstruction using latissimus dorsi mini-flap was done. Seventeen patients had reconstruction with muscle only, while 11 patients had reconstruction by musculocutaneous flap. A deeply satisfied cosmetic result was achieved in (82.1%) and none of them subsequently required mastectomy. After median follow-up of 28 month, the progression free survival was 92.9% and the over all survival was 96.4%. No local recurrence was recorded. Conclusion: Breast augmentation with autologous tissue comes into play by reducing the resultant deformity when the breast volume excised is significant. The Latissimus dorsi flap is the mainstay of oncoplastic breast surgery after partial mastectomy and it has low donor site morbidity, deep patient satisfaction and low and temporary radiation effects.

Background: Breast-conserving surgery plus radiotherapy is firmly established as a good and safe option for most women with early breast cancer. Cosmoses after Breast-conserving surgery depend on two main factors; the site of the lesion and the breast volume excised in relation to total breast volume. Latissimus dorsi miniflap is one of the various autologous tissue reconstructions that can replenishe loss of more than 25% of breast volume. The aim of our study is to evaluate the aesthetic outcome and complications of breast reconstruc-tion using latissimus dorsi miniflap augmentation after wide local excision of the tumor combined with axillary lymph node dissection. Patients and Methods: The study involved twenty eight patients with breast cancer underwent conservative breast surgery in the form of wide local excision with safety margin with immediate reconstruction using Latissimus dorsi miniflap either by muscle only or musculocutaneous flap. Neoadjuvant chemotherapy was given in some cases to reduce the tumor size and after surgery; all cases received eligible adjuvant therapy. Results: Most of the patients (71.4%) were having T2 tumor, while (14.3%) of the patients had T1 tumor and (14.3%) had T3 tumor. Neoadjuvant chemotherapy was given for 14 patients with overall response rate about 76.7%. Wide local excision with safety margin with immediate reconstruction using latissimus dorsi mini-flap was done. Seventeen patients had reconstruction with muscle only, while 11 patients had reconstruction by musculocutaneous flap. A deeply satisfied cosmetic result was achieved in (82.1%) and none of them subsequently required mastectomy. After median follow-up of 28 month, the progression free survival was 92.9% and the over all survival was 96.4%. No local recurrence was recorded. Conclusion: Breast augmentation with autologous tissue comes into play by reducing the resultant deformity when the breast volume excised is significant. The Latissimus dorsi flap is the mainstay of oncoplastic breast surgery after partial mastectomy and it has low donor site morbidity, deep patient satisfaction and low and temporary radiation effects.