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

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

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

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

N

Prognostic value of preoperative staging in gastric cancer

a Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients: a viewpoint in the era of preoperative treatmen

Limited lymph node dissection and metastatic lymph node ratio: a wave of trust

Non

Harlequin Syndrome

non

Education and imaging: gastrointestinal: videocapsule retention: rationale for surgical indication

No abstract is available for this article

Large bowel auto-amputation and passage of a colon 'cast' after left hemicolectomy

No abstract availabl