Il carcinoma colo-rettale nel giovane. Fattori prognostici

Colorectal carcinoma is the third most frequently diagnosed malignant neoplasm. Usually patients affected by this neoplasia belong to VI decade of life. However approximately 2-8% of tumors arise in patients with age under 40 years. Aim of the study was to analyse the results of surgical treatment of colorectal cancer in patiets aged under forty. From January 1987 to December 2002, 46 patients under forty years with colorectal cancer underwent surgical procedure. No perioperative mortality was registered, and complicantions were evidenced in nine patients (20%). Actuarial five years survival was 33%, and overall mean survival was 53 months. Univariate and multivariate analyses identified as prognostic factors the tumor grade, Dukes' stage, nodal status, and length of symptom

Colon or rectal stent positioning for advanced cancer influences quality of life: a critical point of view

Background/Aim: Endoluminal self-expanding metallic stents (SEMS) may overcome the risk of mortality and morbidity of acute intestinal obstruction because of stage IV colon (CC) or rectal (RC) cancer. We evaluated the QoL in these groups of patients. Patients and Methods: Forty-eight patients were enrolled in a prospective longitudinal cohort single-center trial to undergo SEMS positioning. Twenty-five patients had a CC and 23 RC. Karnofsky performance scale, Visual Analogue Scale and the EQ-5D- 5LTM questionnaire were administered before treatment and at 1, 3 and 6 months. Results: Harmonized to the Italian population, the index values showed a statistically significant deterioration of the QoL in patients with RC when compared to those with CC at 1-, 3- and 6-months (1 month: p=0.001; 3- month: p=0.001; 6-month: p=0.045). Similarly, Visual Analogue Scale showed variations at 1- (p=0.008), 3- (p=0.001) and 6-months (p=0.020). Rectal stent deployment was the only independent predictor for a worse QoL in all domains (p<0.017; OR=0.196; 95%CI=0.51-0.749). Conclusion: Patients affected with stage IV CC had a better QoL after SEMS placement when compared to those affected with RC. The persistency of the primary tumor at the rectal level, even if irradiated, might negatively affect QoL

Predictive factors of deep abdominal complications after hydatid cysts of the liver: 15 years of experience with 672 patients.

We read with interest the article by El Malki and collaborators, 1 and we congratulate them for the excellent general results and their ability to share with us their extensive experience in a field that is getting renewed interest in western European countries and the US, mainly because of the increasing phenomenon of immigration from North African countries

Extent of lymphadenectomy and perioperative therapies: Two open issues in gastric cancer

Gastric cancer is one of the leading causes of death for cancer worldwide, although geographical variations in incidence exist. Over the last decades, its incidence and mortality have gradually decreased in Western countries, while these have increased, or remained stable, in the other world regions. Gastric cancer is often diagnosed at an advanced stage, with the only notable exception of Japan, where nationwide screening programs are enforced, due to local high incidence. Curativeintent surgery (i.e., gastrectomy, total or partial, and lymphadenectomy) remains the cornerstone of treatment of gastric cancer. Much has been debated about the extent of lymph node dissection and, although it is a valuable contribution to staging and cure, operative treatment only represents one aspect of overall effective management, as the risk of both locoregional and distant recurrences are high, and bear a poor prognosis. As a matter of fact, surgery, as a single modality treatment, has probably achieved its maximum efficacy for local control and survival, while other accompanying nonsurgical treatment modalities have to be taken into account, although their role is still the subject of considerable debate. The authors in this review present an update on the outcome of treatment of gastric cancer in relation to the extent of lymphadenectomy and of various nonsurgical preoperative, intraoperative, and postoperative strategies. ©2014. Baishideng Publishing Group Co., Limited. All rights reserved

Il cancro del retto nella donna

Gli Autori riferiscono su 92 casi di pazienti di sesso femminile affette da cancro del retto e sottoposte ad intervento chirurgico con intento curativo, nel periodo compreso tra il 1980 ed il 1996, nel Dipartimento di Chirurgia “Pietro Valdoni” della I Facoltà di Medicina e Chirurgia della Università degli Studi “La Sapienza” di Roma. I dati raccolti e analizzati sono quelli demografici e anamnestici, il tipo di intervento chirurgico eseguito, lo stadio e il tipo istologico del tumore. In tutti i casi compresi nello studio è stato eseguito un follow up per un periodo minimo di 5 anni. Particolare attenzione è stata posta sulla presenza e natura di patologie ginecologiche concomitanti e di quelle insorte nel periodo del follow up. Ventidue pazienti erano state sottoposte in precedenza ad isterectomia. In 24 pazienti l’exeresi rettale è stata associata ad una procedura chirurgica sugli organi genitali. Ventuno pazienti sono decedute per progressione della malattia, primitiva e 7 per cause diverse. In due delle pazienti decedute per evoluzione della malattia, questa comprendeva le ovaie. Nel gruppo di pazienti sopravvissute sono stati eseguiti 4 interventi di isterectomia e 2 di ovariectomia. Il reperto di patologie ginecologiche primitive e/o secondarie può porre il chirurgo nella necessità di associare all’intervento di exeresi rettale programmato procedure ginecologiche non previste con conseguenti implicazioni di carattere tecnico e medicolegale. Viene prospettata una serie di condizioni nelle quali potrebbe sembrare opportuno impiegare una ovariectomia profilattica

Impact of radiofrequency energy on intraoperative outcomes of laparoscopic colectomy for cancer in obese patients

Nowadays laparoscopic approach is accepted as a valid alternative to open surgery for the treatment of colorectal cancer. Several studies consider this approach to be safe and feasible also in obese patients, even if dissection in these patients may require a longer operative time and involve higher blood loss. To facilitate laparoscopic approach, more difficult in these patients, several energy sources for laparoscopic dissection and sealing, has been adopted recently. The aim of this study is to investigate the possible intraoperative advantages of radiofrequency energy in terms of blood loss and operative time in obese patients undergoing laparoscopic resection for cancer. All patients who underwent laparoscopic surgery for colorectal cancer from January 2010 to December 2015 were registered in a prospective database. Patients with a body mass index BMI (kg/m2) ≥30 were defined as obese, and patients with a BMI (kg/m2) <30 were defined as non-obese. All 136 obese patients observed were divided retrospectively into 2 groups according to the devices used for dissection: 83 patients (Historical group: B) on whom dissection and coagulation were performed using other energy sources (monopolar electrocautery scissors, bipolar electrical energy, ultrasonic coagulating shears) and 53 patients who were treated with electrothermal bipolar vessel sealing (Caiman group: A). In group A, the Laparoscopic Caiman 5 (Aesculap AG, Tuttlingen, Germany) was the only instrument employed in the whole procedure. The study examined only three types of operation: right colectomy (RC), left colectomy (LC), and anterior resection (AR). Preoperative data were similar for RC, LC, and AR in both groups (A and B). The mean operative time was statistically shorter in the Caiman group than in the Historical group [104 vs 124 min (p 0.004), 116 vs 140 min (p 0.004), and 125 vs 151 min (p 0.003) for RC, LC, and AR between group A and B, respectively]. Also intraoperative blood loss results significantly lower in the Caiman group than in the historical one [52 ml vs 93 for RC (p 0.003); 65 vs 120 ml for LC (p 0.001); 93 vs 145 ml for AR (p 0.002) between group A and B, respectively]. No intraoperative complications were recorded in either group. The mean conversion rate was 4.4% (6 patients). There were no statistical differences in intensive care unit (ICU) stay, functional outcomes, mean hospital stay and overall morbidity rate between the two groups. There was no mortality in either group. The use of the Caiman EBVS instrument shows significant advantages with respect to a small number of intraoperative parameters. We can conclude that use of this radiofrequency device, in the laparoscopic approach, offers advantages in terms of lower intraoperative blood loss and shorter operative time in obese patients with colorectal cancer

Desmoplastic fibroblastoma of the thigh: A case report

Desmoplastic fibroblastoma (DF) is an extremely rare benign soft tissue tumor, prevalent in adult men, mostly arising in deep regions of extremities. The tumor presents with a slowly growing and no recurrence or metastases after surgical excision. Histologically, DF is characterized by a collagenous stroma that contains spindle- and stellated-shaped fibroblastic cells positive for vimentin. Differential diagnosis with locally aggressive soft tissue tumors could be difficult. This case report deals with the clinical, pathological and immunoistochemical features of a DF of the left thigh in a 63-years old man

Management of bronchobiliary fistula as a complication of liver hydatidosis

[No abstract available