Surgical resection for gastrointestinal stromal tumors (GIST): experience on 25 patients

BACKGROUND: Gastrointestinal stromal tumors (GIST) are infrequent and diagnosis and prognosis could be troublesome. We present short and long term results of surgical resection for GIST at the Department of Surgery, University of Insubria, during a period of 17 years. MATERIALS AND METHODS: All patients' data, tumor characteristics, surgical procedure and survival data were analyzed retrospectively. Tumors were divided in risk classes using the classification proposed by Fletcher, based on tumor size and number of mitosis. RESULTS: Between 1987 and 2004, 25 patients underwent surgical resection for GIST. Stomach was the most common site of localization. Complete resection was achieved in 88% cases, while in 12% radical resection was not possible. The mean tumor size was 9.2 cm (1.2 – 30 cm): <5 cm diameter in 14/25 cases (56%), 5–10 cm in 5/25 (20%) and >10 cm in 6/25 (24%). Mitotic count was <10/50 HPF in 68% (17/25) and >10/50 in 32% (8/25). Using Fletcher's classification, tumors were divided in very low (11/25, 44%), low (4/25, 16%), intermediate (6/25, 24%) and high-risk (4/25, 16%) groups. The 5-year overall survival was 65% and 34% respectively with a statistically significant difference between tumors <5 cm and >10 cm in diameter and between complete and incomplete resection. High-risk tumors had a significantly shorter survival than low or very low risk. CONCLUSION: Our experience confirms that GIST's are uncommon and aggressive cancers. The prognosis is strictly related to tumor size and number of mitosis. Although significant advances on new chemotherapeutic regimes have been made, to date, only radical surgery offers the chance of long-term survival

Solitary pulmonary metastasis from primary melanoma of the oesophagus 5 years after resection of the primary tumor

BACKGROUND: Primary malignant melanoma of the oesophagus (PMME) is an uncommon tumor. PMME has an aggressive biological behavior, similar to melanomas developed elsewhere in the body. Most patients die from distant metastases, and the overall 5 year survival rate is approximately 4%. CASE PRESENTATION: We report a rare case of a solitary pulmonary metastasis found 5 years after curative resection of primary esophageal melanoma. No other sites of metastatic disease were identified. Video-assisted lung wedge resection of the lung nodule was carried out successfully. CONCLUSION: This supports the concept that patients with primary melanoma of the oesophagus treated should be carefully followed up

Reconstruction after esophagectomy in patients with [partial] gastric resection. Case report and review of the literature of the use of remnant stomach

BACKGROUND: Bowel reconstruction after subtotal esophagectomy represents a problem when a previous distal gastrectomy was performed: usually the colon or jejunum is used. METHODS: In a 10 year period 126 patients with primary esophageal cancer underwent esophageal resection in our Department. Surgical procedures were 57% two-phase subtotal oesophagectomy, 23% transhiatal, 9% stripping, 10 three-phase total esophagectomy and 2 endoscopic resections. RESULTS: In 112 patients alimentary tract reconstruction was achieved by means of esophago-gastric anastomosis. Reconstruction was performed using colon in 10 cases and jejunum in 2. We describe the technical aspects of esophagectomy and gastric reconstruction in a patient with previous antrectomy and Billroth II reconstruction. The procedure was performed via a combined laparotomy and thoracotomy with anastomosis at the level of the azygous vein using the remnant stomach. CONCLUSION: Few technical reports have been reported in literature about the use of remnant stomach in reconstruction for subtotal esophagectomy subsequent to distal gastrectomy. Several hypotheses are made to explain the maintenance of the gastric vascular integrity as its intramural network without micro-vascular anastomosis

Distress, qualità della vita, supporto sociale, capacità adattativa e disturbi cognitivi in un campione di pazienti affette da carcinoma della mammella in fase pre e postoperatoria.

Introduzione L’area di intervento senologica tratta un prioritario problema umanitario e sociale: si ammalano di tumore al seno donne e uomini, che vanno incontro a disagi psichici ed emotivi, familiari, lavorativi, riproduttivi. Come in precedenza osservato, il carcinoma della mammella (CM) è diventato il tumore più frequente in assoluto e il primo nella popolazione femminile in tutte le fasce di età. Dal 2016 l’AIOM annuncia un calo negli indici di mortalità del cancro: negli ultimi dieci anni si riscontra un + 15% di guarigioni. A partire da evidenze scientifiche in precedenza descritte, gli Organismi di tutela pubblica sostengono la prospettiva multidisciplinare nella cura sia della malattia sia della persona affetta da (CM). Nell’Equipe lo psiconcologo ha un importante ruolo di supporto ai bisogni dei pazienti e di ricerca clinica. Il tema dei bisogni delle pazienti con CM è stato a lungo indagato in letteratura internazionale, ma poco nel contesto italiano. Gli studi sottolineano l’incidenza della malattia e delle conseguenze delle cure sulla qualità di vita (QdV) della paziente: circa il 25% dei casi sviluppa distress, ansia, depressione. Metodi studio osservazionale longitudinale monocentrico che ha previsto l’arruolamento di 205 soggetti ai quali sono stati somministrati i questionari citati in seguito, noti in letteratura. Sono tutti questionari tradotti e validati in italiano. Le 205 donne sono state arruolate tra novembre 2018 e settembre 2019 e contattate in quattro momenti cruciali del percorso, più avanti descritti, nei primi due anni del percorso di cura. Conclusioni I nostri dati confermano che l’esperienza di una diagnosi di CM è di per sé fonte di distress, indipendentemente dalla serietà della condizione iniziale, delle prospettive di cura o della prognosi. Descrizione del campione. Su una popolazione di 246 pazienti candidabili, 41 (17%) hanno rifiutato di partecipare per mancanza di interesse o per la provenienza da regioni lontane. Delle 205 pazienti arruolate nella ricerca 171 (83%) hanno restituito i questionari alla diagnosi (T0), 158 (77%) nel postoperatorio (T1), 146 (71%) a un anno (T2), 143 (70%) a due anni (T3). Per quanto riguarda i dati clinici, il 79,5% è candidato alla chirurgia come prima soluzione terapeutica (il restante 20,5% a chemioterapia neoadiuvante). Il 57.3% ha effettuato quadrantectomia (mono o bilaterale) e il 42.6% mastectomia (mono o bilaterale). La dissezione ascellare è stata effettuata nel 28.8% dei casi. Le pazienti candidate a chemioterapia adiuvante sono il 35.1%, a terapia ormonale il 78% e il 70.7% a radioterapia. Il 55,4% ha incontrato almeno una volta lo psiconcologo. Le cure aumentano il livello di compromissione fisica nel tempo, di peggioramento globale della QdV e di fatigue emotiva e cognitiva generale. Colpisce il fatto che in generale il distress non sia elevato alla diagnosi e diminuisca già nel postoperatorio: si ritiene questo l’effetto di una angoscia legata alla natura della malattia oncologica, la cui nominazione già di per sé suscita vissuti di profonda angoscia. Si ritiene altresì che la presa in carico da parte di un’Equipe dedicata, la cui esperienza sia certificata, produca un effetto di sollievo nelle pazienti, una volta entrate nel dispositivo delle cure. Si conferma necessario il monitoraggio psiconcologico di tutte le pazienti alla diagnosi

Injection of colorectal cancer cells in mesenteric and antimesenteric sides of the colon results in different patterns of metastatic diffusion: An experimental study in rats

BACKGROUND: This experimental study was designed to investigate the differences in pattern of local growth and diffusion of colorectal cancer cells injected into either mesenteric (M) or antimesenteric (AM) sides of the colon. METHODS: A total of 1 × 10(6 )colonic adenocarcinoma cells (line DHD/K12-TRb) were injected into the cecal wall of BDIX syngeneic male rats at an M or AM site of the colon. At six weeks after injection, all animals were sacrificed and the presence or absence of tumor in the cecum as well as regional metastasis and peritoneal carcinomatosis were determined. RESULTS: Six weeks after injection, macroscopic tumor growth was observed in 27/37 (72%) animals in group M and 21/32 (65%) in group AM (P = 0.98). In group AM, diffuse peritoneal carcinomatosis was present in 19/21 rats (90.4%) versus 3/27 rats (11%) in group M; this difference was statistically significant (P = 0.025). Regional mesenteric lymph nodes were the only location in which tumor was detected in 23/27 rats (85%) in group M versus 2/21 (9.5%) in group AM; this difference too was statistically significant (P = 0.031) CONCLUSION: The patterns of diffusion of tumors implanted in mesenteric and antimesenteric sites of the colon appear to be different, although the reason for this is not clear

Solitary pulmonary metastasis from primary melanoma of the oesophagus 5 years after resection of the primary tumor

Primary malignant melanoma of the oesophagus (PMME) is an uncommon tumor. PMME has an aggressive biological behavior, similar to melanomas developed elsewhere in the body. Most patients die from distant metastases, and the overall 5 year survival rate is approximately 4%. We report a rare case of a solitary pulmonary metastasis found 5 years after curative resection of primary esophageal melanoma. No other sites of metastatic disease were identified. Video-assisted lung wedge resection of the lung nodule was carried out successfully. This supports the concept that patients with primary melanoma of the oesophagus treated should be carefully followed up

Ten year survival after excision of squamous cell cancer in Zenker's diverticulum: report of a case

BACKGROUND: Zenker's diverticulum (ZD) has been increasingly recognized as a site of primary epithelial malignancy. Pitt in 1896 described the first case. METHODS: Between 1990 and 2005, 30 patients affected of esophageal diverticulum were referred to our Department. RESULTS: The pathological results revealed one case of squamous cell carcinoma. On follow-up 10 years after diverticulectomy alone, the patient was alive and well without evidence of recurrence. CONCLUSION: Our case reported provides additional data on clinical decision when the tumor is well localized without full-thickness penetration or extension to the line of resection. In this patient, long-term survival and apparent disease control have been effected by diverticulectomy alone. A case of such long survival is very rare

Loco-Regional Recurrence and Cancer-Related Death after Breast Cancer Surgery

:  To determine which tumor-related factors might predispose the patient to loco-regional recurrence or death and the impact of these factors on the different types of events. We retrospectively analyzed the data of 1991 women between January 1998 and March 2010 for a first primary nonmetastatic breast cancer and treated with surgery and neo-adjuvant/adjuvant therapy. The overall survival distribution was estimated using the Kaplan–Meier method. The prognostic impact of several factors on cumulative overall and loco-regional recurrence free survival was evaluated by univariate (log-rank test) and multivariate analysis (Cox regression). At log-rank test, pT, nodal status, histotype, grading, lymphangioinvasive growth, tumor diameter, estrogen receptors (ER) status, progesterone receptors (PR) status, expression of Ki67, and expression of Her2/neu had a prognostic value on loco-regional recurrence or overall survival. In the multivariate analysis grading remained the only independent predictor of loco-regional recurrences. With regard to overall survival, the Cox model selected grading along with nodal status and PR status. Loco-regional recurrences after breast cancer surgery are not frequent events. They are markers of tumor aggressiveness and predictor of an increased likelihood of cancer-related death. However, loco-regional recurrence and systemic tumor progression are partially independent events, since some prognostic factors differ

Identifying factors contributing to reduced breast tumor size: A longitudinal study

AbstractAimThis study examines the trends and outcomes of breast cancer patients who have undergone surgical procedures at the Department of Surgical Sciences, University of Insubria, Varese, Italy. It also identifies the factors that contributed to the reduction of the breast tumor size over a 13-year period at a tertiary referral center.MethodsAll breast cancer operations performed at the Department of Surgical Sciences, University of Insubria, Varese, Italy, from January 1992 to June 2005 were examined and data from their surgical pathology reports were also analyzed, using a prospective database. A longitudinal study was performed to compare and analyze the pathological data during three consecutive time periods. The periods were from 1992 to 1996, 1997 to 1999, and 2000 to 2005. Surgical and pathological outcomes included age of the patient at the time of the diagnosis, partial breast resections, mastectomies, axillary lymphadenectomies, tumor size, histological type and stage, and lymph node status.ResultsThe study group was comprised of 3050 patients who underwent breast resection between 1992 and 2005. Quadrantectomy was the preferred surgical approach in 1759 patients (58%). Throughout the longitudinal study, the tumors measuring less than 1cm increased from 13.4% to 15.4%; the number of tumors diagnosed at stage I increased from 44.1% to 56.8%; the most frequent histological type was ductal carcinoma; the number of ductal carcinomas in situ (DCIS) increased from 4% to 6%; and the incidence of lymphadenectomies decreased from 71.6% to 52.5%. Perioperative factors that correlated with the decreased size of the tumor over time were: screening, improvement of diagnostic and therapeutic techniques, and the increased operative use of sentinel lymph node biopsy (SLNB).ConclusionsThere has been an evolving refinement in surgical technique and perioperative management of breast cancer patients undergoing surgical resection at the Department of Surgical Sciences, University of Insubria, Varese, Italy, during the past decades. The present longitudinal study on 3050 surgical breast cancer patients confirmed the progressive reduction of tumor size at the time of the diagnosis. Perioperative factors that correlated with the decreased tumor size over time were mammography screening, improvement of diagnostic and therapeutic techniques, and the use of SLNB. Furthermore, the study showed that the progressive reduced number of useless axillary lymphadenectomies was mainly due to the increased intraoperative use of axillary SLNB

Laparoscopic Left Liver Sectoriectomy of Caroli's Disease Limited to Segment II and III

Caroli's disease is defined as a abnormal dilatation of the intra-hepatica bile ducts: Its incidence is extremely low (1 in 1,000,000 population) and in most of the cases the whole liver is interested and liver transplantation is the treatment of choice. In case of dilatation limited to the left or right lobe, liver resection can be performed. For many year the standard approach for liver resection has been a formal laparotomy by means of a large incision of abdomen that is characterized by significant post-operatie morbidity. More recently, minimally invasive, laparoscopic approach has been proposed as possible surgical technique for liver resection both for benign and malignant diseases. The main benefits of the minimally invasive approach is represented by a significant reduction of the surgical trauma that allows a faster recovery a less post-operative complications