Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients

<p>Abstract</p> <p>Background</p> <p>This study evaluates the surgical morbidity and long-term outcome of colorectal cancer surgery in an unselected group of patients treated over the period 1994–2003.</p> <p>Methods</p> <p>A consecutive series of 902 primary colorectal cancer patients (489 M, 413 F; mean age: 63 years ± 11 years, range: 24–88 years) was evaluated and prospectively followed in a university hospital (mean follow-up 36 ± 24 months; range: 3–108 months). Perioperative mortality, morbidity, overall survival, curative resection rates, recurrence rates were analysed.</p> <p>Results</p> <p>Of the total, 476 colorectal cancers were localized to the colon (CC, 53%), 406 to the rectum (RC, 45%), 12 (1%) were multicentric, and 8 were identified as part of HNPCC (1%). Combining all tumours, there were 186 cancers (20.6%) defined as UICC stage I, 235 (26.1%) stage II, 270 (29.9%) stage III and 187 (20.6%) stage IV cases. Twenty-four (2.7%) cases were of undetermined stage. Postoperative complications occurred in 38% of the total group (37.8% of CC cases, 37.2% of the RC group, 66.7% of the synchronous cancer patients and 50% of those with HNPCC, p = 0.19) Mortality rate was 0.8%, (1.3% for colon cancer, 0% for rectal cancer; p = 0.023). Multivisceral resection was performed in 14.3% of cases. Disease-free survival in cases resected for cure was 73% at 5-years and 72% at 8 years. The 5- and 8-year overall survival rates were 71% and 61% respectively (total cases). At 5-year analysis, overall survival rates are 97% for stage I disease, 87% for stage II, 73% for stage III and 22% for stage IV respectively (p < 0.0001). The 5-year overall survival rates showed a marked difference in R0, R1+R2 and non resected patients (82%, 35% and 0% respectively, p < 0.0001). On multivariate analysis, resection for cure and stage at presentation but not tumour site (colon vs. rectum) were independent variables for overall survival (p < 0.0001).</p> <p>Conclusion</p> <p>A prospective, uniform follow-up policy used in a single institution over the last decade provides evidence of quality assurance in colorectal cancer surgery with high rates of resection for cure where only stage at presentation functions as an independent variable for cancer-related outcome.</p

Malattia diverticolare

Il riscontro di diverticoli del colon rappresenta una situazione molto frequente nei paesi industrializzati, con una incidenza che aumenta con l'eta cos\uec da coinvolgere pi\uf9 del 65% degli ultra ottantenni. Legata alla presenza di diverticoli possono svilupparsi poi tutta una serie di patologie che possono necessitare, nel 20-25 % dei casi, anche un intervento chirurgico . Nel Capitolo vengono analizzati, oltre ad alcuni dati epidemiologici, aspetti fisiopatologici, anatomo patologici, diagnostici, clinici e di terapia Medica e Chirurgica della malattia Diverticolare

Estensione della linfadenectomia nella chirurgia colo-rettale: problema aperto.

Il fine del presente lavorto retrospettivo \ue8 stato quello di analizzare se una una linfadenectomia estesa alla radice dei vasi colici principali poteva assumenre un significato prognostico e/o terapeutico. Dalla analisi dei dati \ue8 emerso che rinuciando ad una linfadenectomia estesa, solo per il fenomeno del "salto del linfonodo" si sarebbe verificata una sottostadiazione del 1,4% fra N0/N+ e del 8,5% fra N2/N3. Inoltre, sempre con una linfadenectomia estesa, si \ue8 osservato una sopravvivenza a 5 anni del 32,7% anche nei pazienti con metastasi ai linfonodi centrali. Non si sono invece osservate differenze significative nella mortalit\ue0 e morbilit\ue0 in rapporto al tipo di linfodenenctomia eseguita. Gli autori concludono considerando la linfadenectomia estesa ai linfonodi centrali il livello ideale di dissezione, sola in grado di garantire non solo una correta stadiazione ma anche un miglioramento della prognosi sopratutto per i pazienti N+

Lumboaortic and iliac lymphadenectomy: what is the role today?

PURPOSE: The aim of this study was to evaluate the roles of the lymphadenectomy in the surgical treatment of rectal cancer. METHODS: On the basis of our experience of 252 curative operations for rectal cancer, we analyze survival and recurrence in relation to the lymph node involvement and to the level of the lymph nodes where the metastases are located. All patients underwent a lymphadenectomy with high ligation of the inferior mesenteric artery and removal of the lumboaortic lymph nodes from the left renal vein to the aortic bifurcation. Pelvic lymphadenectomy was performed in 16 cases. RESULTS: Five-year survival was 70.6 percent in patients with no lymph node involvement, 68.2 percent in patients with pararectal lymph nodes N+, 25 percent in patients with involvement of intermediate lymph nodes, and 30 percent in patients with involvement of lumboaortic lymph nodes. In no case was there involvement of the hypogastric lymph nodes. On the basis of our experience and from results in the literature, we consider an upward extended lymphadenectomy with high ligation of the inferior mesenteric artery is warranted since it enables the tumor to be staged accurately and may lead to survival even in cases of advanced lymph node involvement

Adhesive small bowel occlusion: a clinical and therapeutic study of 163 consecutive patients.

The aim of this retrospective study is to evaluate the immediate and late outcomes of the surgical and conservative treatment of adhesive small bowel obstruction. A series of 163 consecutive patients affected by adhesive occlusion were analysed. 63 patients were submitted to emergency surgery and 100 to conservative treatment; 15 of these ones were operated on because they did not improve or deteriorated. The in-hospital mortality and morbidity, the length of the ileus, the time required for the operatori, the length of the recovery, and the late results after a median follow-up of 3.6 years (range: 1-6 years) are reported. The overall mortality was 3.26% and there was no significant difference (p = 0.764) between the treatment modalities. The patients submitted to conservative therapy had a lower morbidity, shorter length of the ileus and shorter hospital stay and a better outcome at follow-up. In the surgical group, the patients submitted to emergency surgery had a lower mortality, a shorter ileus and shorter hospital stay than the patients submitted to delayed surgery. Conservative treatment of adhesive occlusions should be opted for when the indications are correct (no intestinal ischaemia, no occlusion by a bridle). In doubtfui cases, the patient should be submitted to emergency surgery to avoid the risks of surgical delay