Urachal tumour: case report of a poorly understood carcinoma

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Predictive values of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8

Objectives: Comprehensive Geriatric Assessment (CGA), the gold standard for detecting frailty in elderly cancer patients, is time-consuming and hard to apply in routine clinical practice. Here we compared the performance of two screening tools for frailty, G8 and SAOP2 for their accuracy in identifying vulnerable patients. Material and Methods: We tested G8 and SAOP2 in 282 patients aged 65 or older with a diagnosis of solid cancer and candidate to undergo surgical, medical and/or radiotherapy treatment. CGA, including functional and cognitive status, depression, nutrition, comorbidity, social status and quality of life was used as reference. ROC curves were used to compare two screening tools. Results: Mean patient age was 79 years and 54% were female. Colorectal and breast cancer were the most common types cancer (49% and 24%). Impaired CGA, G8, and SAOP2 were found in 62%, 89%, and 94% of the patients, respectively. SAOP2 had a better sensitivity (AUC 0.85, p<0.032) than G8 (AUC 0.79), with higher performance in breast cancer patients (AUC 0.93) and in patients aged 70-80 years (AUC 0.87). Conclusions: G8 and SAOP2 both showed good screening capacity for frailty in the cancer patient population we examined with SAOP2 showing a slightly better performance than G8

Deiscenza di anastomosi colorettale dopo terapia neoadiuvante con bevacizumab. Case report

Premessa. Nonostante i progressi ottenuti nelle ultime decadi nel trattamento del cancro del retto, la deiscenza anastomotica continua ad essere la principale complicanza chirurgica. Pazienti e metodi. Si riportano due casi di pazienti con quadro di piccola deiscenza, o forse di microperforazione, dopo resezione anteriore del retto, entrambi trattati con bevacizumab. I pazienti erano affetti da adenocarcinoma del retto inferiore e avevano ricevuto una terapia neoadiuvante secondo il protocollo sperimentale di fase II ROCHE ML 18522 (comprendente Xeloda®, Avastin® e radioterapia). A distanza rispettivamente di uno e due mesi dall’intervento chirurgico di resezione anteriore del retto, con anastomosi ultrabassa e colostomia temporanea, i pazienti hanno presentato un quadro clinico-strumentale di ascesso pelvico presacrale, che ha reso necessari il ricovero e l’instaurazione di una terapia antibiotica, in un caso associata al posizionamento di un drenaggio sotto guida TC. Risultati. Ambedue i pazienti hanno avuto un decorso favorevole ed è stata soppressa la colostomia derivativa a distanza di sei mesi e un anno dall’intervento. Discussione. Sono state segnalate in corso di terapia con bevacizumab, anticorpo monoclonale contro il VEGF (Vascular Endothelial Growth Factor), perforazioni gastrointestinali “spontanee”, anche in pazienti affetti da tumori non digestivi; verosimilmente esse sarebbero indotte dalla capacità del farmaco di inibire la neoangiogenesi. Conclusioni. Molta attenzione va rivolta agli “effetti indesiderati” del trattamento neoadiuvante combinato del cancro del retto, valutando, in presenza di determinati fattori di rischio, il confezionamento di una colostomia temporanea

Gastric Abrikosoff tumor (granular cell tumor): case report

Il tumore a cellule granulari, anche detto tumore di Abrikosoff, è una neoplasia rara di derivazione neurale. È caratterizzato dalla presenza di cellule granulari; sono conosciute forme a comportamento sia benigno che maligno, anche se queste ultime sono poco frequenti. Si presenta con una leggera predominanza nel sesso femminile e nella razza nera; lo spettro dell’età è ampio, con un picco tra la quarta e la sesta decade. Può localizzarsi in tutti gli epiteli, anche se le lesioni cutanee (testa, collo, tronco ed estremità) sono molto più frequenti di quelle viscerali (esofago, stomaco, intestino tenue, colon, laringe, bronchi, colecisti, vie biliari). L’exeresi chirurgica “en bloc” è terapeutica sia nelle forme benigne che nelle maligne. La chemioterapia e la radioterapia non sono efficaci. Riportiamo il caso di un uomo di 45 anni al quale, a seguito di una esofagogastroduodenoscopia con biopsie effettuata per pirosi epigastrica, era stata posta diagnosi citopatologica di tumore stromale a cellule fusate del fondo gastrico. È stato sottoposto a resezione a losanga della parete gastrica. All’esame istologico le cellule presentavano granulazioni citoplasmatiche e l’esame immunoenzimatico dimostrava positività per proteina S100, PGP 9.5 e NSE. L’escissione locale completa è sufficiente e scongiura il rischio di recidiva e metastasi: tuttavia è opportuno un follow-up endoscopico a lungo termine

Factors influencing 12 or more harvested lymph nodes in resective R0 of the colorectal cancer

The number of lymph nodes required for accurate staging is a critical component in colorectal cancer (CRC). This study was designed to determine the factors that influence the number of harvested lymph nodes (≥12) in resective R0 early-stage CRC in a single institution. A total of 100 patients (71.9%) with 12 or more harvested lymph nodes and 39 patients (28.1%) with < 12 lymph nodes were analyzed. The number of harvested lymph nodes was highly variable in patients who underwent resection of R0 CRC. Neither the surgeon nor the pathologist had significant influence on the number of harvested lymph nodes. Therefore, from the viewpoint of the surgeons, disease itself is the most important factor influencing the number of harvested lymph nodes

Delirium, Frailty, and Fast-Track Surgery in Oncogeriatrics: Is There a Link?

Background/Aims: Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer. Methods: A total of 107 consecutive subjects admitted for elective colorectal FTS were enrolled. All patients underwent CGA, frailly stratification, Timed up &amp; go (TUG) test, 4AT test for delirium screening, anesthesiologists physical status classification, and Dindo-Clavien classification. Results: The incidence of POD was 12.3%. Patients’ prevalent clinical phenotype was pre-frail. The multivariate analysis indicated physical performance (TUG in seconds) as the most significant predictor of POD for each second of increase. Conclusions: Only few procedure-specific studies have examined the impact of FTS for colorectal cancer on POD. This is the first study to investigate the risk factors for POD, in a vulnerable octogenarian oncogeriatric population submitted to FTS surgery and frailty stratification

Primary omental torsion: A case report

A patient presented with an acute abdomen at the Emergency Department. The patient, a 69-year-old man, was admitted and underwent surgery with a provisional diagnosis of acute appendicitis. During surgery, omental torsion was diagnosed and the involved omentum was removed. The patient had no previous surgical history. Omental torsion is a rare cause of acute abdomen in children and adults who may present with various signs and symptoms; a preoperative diagnosis may therefore be difficult and can usually only be established during surgery