The Road to Curative Surgery in Gastric Cancer Treatment: A Different Path in the Elderly?

BACKGROUND: The aim of this study was to evaluate the possibility of a different path to achieve curative surgery in patients older than age 70 years and affected by resectable gastric cancer. STUDY DESIGN: This is a multicentric retrospective study based on an analysis of 1,465 patients with gastric adenocarcinoma who underwent surgery with curative intent. Patients were divided into 2 age groups (younger than 70 years vs older than 70 years) and were evaluated with respect to postoperative morbidity and mortality and survival. RESULTS: Postoperative morbidity and mortality in elderly and nonelderly groups were 24.8% vs 20.6% and 2.6% vs 3.7%, respectively (p = NS). In the elderly group, multivisceral resection was independently associated with surgical complications (hazard ratio [HR] = 1.988; 95% CI, 1.124-3.516; p = 0.018), total gastrectomy with medical complications (HR = 2.007; 95% CI, 1.165-3.459; p = 0.012), and higher postoperative mortality (HR = 4.319; 95% CI, 1.571-11.873; p = 0.005); D1 lymph node dissection was predictive of a lower postoperative mortality rate (HR = 0.219; 95% CI, 0.080-0.603; p = 0.003). Five-year overall survival rates differed significantly in young and elderly patients (58.9% vs 38.9%; p < 0.001), and 5-year cancer-specific survival did not show any significant difference. CONCLUSIONS: Age should not be considered as a factor in the selection of treatment for gastric cancer patients. Curative surgery can be performed as safely in elderly patients as in younger patients, with comparable postoperative results and long-term survival rates, although the life expectancy of elderly patients is shorter

R0 resection in the treatment of gastric cancer: Room for improvement

Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor. In particular, lymphatic metastasis is one of the main predictors of tumor recurrence and survival, and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection. This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage, with lymph node metastasis at diagnosis. All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols, tailoring the extent of resection and the administration of preoperative and postoperative treatment. The goals of all these strategies are to improve prognosis towards the achievement of a curative resection (R0 resection) with minimal morbidity and mortality, and better postoperative quality of life

Morbidity and postoperative hospital stay in colorectal cancer surgery

Knowledge of clinical factors influencing length of postoperative stay and development of complications could allow an early identification of patients subgroups requiring different postoperative care and surveillance. The aim of this study was to identify factors that can predict morbidity, mortality and hospital stay after colorectal cancer surgery. In our series, surgical complication, rectal and left colon tumor localization, ASA score, extraperitoneal anastomosis, presence of stoma, neoadjuvant therapy and advanced age were associated with a postoperative stay. Severe postoperative complications were more frequent in male, ASA III-IV patients who underwent anterior resection. Colon, rectum, cancer surgery, hospitalization length, complications

Combined ultrasonic aspiration and saline-linked radiofrequency precoagulation: a step toward bloodless liver resection without the need of liver inflow occlusion: analysis of 313 consecutive patients

Background: Hemorrhage is undoubtedly one of the main factors contributing to morbidity and mortality in liver resections. Vascular occlusion techniques are effective in controlling intraoperative bleeding, but they cause liver damage due to ischemia. We evaluated the effectiveness and safety of using a combined technique for hepatic parenchymal transection without liver inflow occlusion. Methods: Three hundred and thirteen consecutive patients who underwent liver resection in four hepato-pancreato-biliary units. Hepatic parenchymal transection was carried out using a combined technique of saline-linked radiofrequency precoagulation and ultrasonic aspiration without liver inflow occlusion. Results: During the study period 114 minor and 199 major hepatic resections were performed. The mean amount of intraoperative blood loss was 377 ml (SD 335 ml, range 50 to 2,400 ml) and the blood transfusion rate was 10.5%. The median amount of blood loss during parenchymal transection and parenchymal transection time was 222 ml (SD 224 ml, range 40 to 2,100 ml) and 61 minutes (range 12 to 150 minutes) respectively. There were two postoperative deaths (0.6%). Complications occurred in 84 patients (26.8%) and most complications were minor. Conclusions: Combined technique of saline-linked radiofrequency ablation and ultrasonic aspiration for liver resection is a safe method for both major and minor liver resections. The method is associated with decreased blood loss, reduced postoperative morbidity, and minimal mortality rates. We believe that this combined technique is comparable to other techniques and should be considered as an alternative

Adoption of a Newly Introduced Dermal Matrix: Preliminary Experience and Future Directions

Introduction. Acellular dermal matrix (ADM) products are adopted in the management of injuries to soft tissues. ADMs have been increasingly employed for their clinical advantages, and they are acquiring relevance in the future of plastic surgery. The aim of our study is to evaluate the application of ADMs in our patients who could not undergo fast reconstruction. Materials and Methods. We performed a retrospective study on 12 patients who underwent ADM placement for scalp and limb surgical reconstructions at the Humanitas Research Hospital, Rozzano (Milano), Italy. Wounds resulted from 9 tumor resections and 3 chronic ulcers. The ADM substrate used to treat these lesions was PELNAC™ (Gunze, Japan), a double-layered matrix composed of atelocollagen porcine tendon and silicon reinforcement. All patients underwent a second surgical operation to complete the treatment with a full-thickness skin graft to cover the lesion. Results. In this study, 12 patients were treated with PELNAC™: 11 out of 12 patients showed a good attachment over a median time of 21.3 days (range 14-27). After almost 23 days, all patients were ready to undergo a full-thickness skin grafting. Conclusion. This study assesses the benefits of PELNAC™ and proposes this method as an alternative to traditional approaches, especially in situations where the latter techniques cannot be applied

Primary pelvic soft tissue sarcomas (PELVISARC): outcomes from the TransAtlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG)

International audienceNo abstract availabl

Towards the goal of r0 resection in locally advanced gastriccancer through the path of neoadjuvant chemotherapy e impact of tumour downstaging on survival in a single series.

Background: Long term survival after R0 resection in locally advanced gastric cancer (LAGC) remains poor, suggesting that a true curative treatment is seldom performed. Preoperative treatment protocols have been proven to be effective in LAGC by large-scale randomized trials; this theoretically happens through an increased control on both distant and loco-regional recurrencies. Aim of this study is the evaluation of the effects on the primary tumour, along with its lymphatic basin, induced by preoperative chemotherapy and the survival impact on a single series of locally advanced gastric carcinomas. Methods: 47 patients with LAGC, staged by laparoscopy, underwent D2-gastrectomy after preoperative chemotherapy. The effects of preoperative treatment were evaluated by a quantitative analysis , which determined the percentage of residual vital tumour cells in the surgical specimens, and by a qualitative analysis , which evaluated the achievement of 8 ABSTRACTStumour-downstaging (T/dwn) induced by any grade of pathologic response. T/dwn after preoperative chemotherapy was assessed comparing pre-treatment clinical and laparoscopic staging with post-operative pathologic staging. The c2 test was used to evaluate the significance of statistical differences among sub-groups. Survival was calculated by Kaplane Meier method and the prognostic signi\ufb01cance of prognostic factors was determined by means of univariate analysis (log-rank test). Multivariate analysis was performed using the Cox proportional hazard model in backward stepwise regression. Results: "Quantitative analysis" of pathologic response was unable to show a clear prognostic signi\ufb01cance. T/dwn was obtained in 25 out of 47 patients. T/dwn was associated with a smaller tumour diameter (34 mm. mean-diameter in T/dwn group versus 55 mm.mean-diameter in non-T/dwn group, p\ubc0.002) and a higher R0-resection rate (96% in T/dwn group versus 72% in no-T/dwn group, p\ubc0.04). Overall survival at 5 years was 55%. In those patients who bene\ufb01ted from a R0-resection (40/47 patients: R0-resection rate \ubc 85%) overall survival reached up to 63%. At univariate and multivariate analysis, R0-resection was found to be an independent prognostic factor (R1-2/R0: HR 6.250/1, p\ubc0.002). Conclusions: In this study, R0-resection was the most important prognostic factor for LAGC selected to be treated by preoperative chemotherapy. Patients who obtained T/dwn had a de\ufb01nitely better chance of cure, mainly through the achievement of a true R0-resection

REGATTA trial: a call for the USA and Europe

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